Joint Committee on Children, Equality, Disability, Integration and Youth debate -
Tuesday, 27 Jun 2023

Challenges Facing Refugee and Migrant Children in Ireland: Discussion

An Cathaoirleach

Apologies have been received from Deputy Cairns. The agenda item for consideration this afternoon is the challenges facing refugee and migrant children in Ireland. This afternoon we are joined by representatives from the Department of Education, Mr. Tomás Ó Ruairc, assistant secretary, and Ms Linda Ramsbottom, senior inspector. From Tusla, we are joined by Ms Kate Duggan, who is the interim chief executive officer; Ms Clare Murphy, who is the national director of services and integration; and Ms Lorna Kavanagh, area manager of national services and integration. From the Movement of Asylum Seekers in Ireland, MASI, we are joined by Ms Sharon Mpofu - I apologise if I am pronouncing any of the names incorrectly - who is the Wicklow co-ordinator and Ms Vepuu Tjazerua, who is the chief executive officer. From Safetynet Primary Care, we are joined by Dr. Alva Ó Dalaigh, migrant health GP lead and Dr. Fiona O'Reilly, chief executive officer. We are also joined by Dr. Aoibhinn Walsh, consultant paediatrician with a special interest in inclusion health. They are all very welcome to the meeting.

Before witnesses go through their opening statements, I will go through the normal housekeeping matters. I advise anyone joining us on Teams that the chat function is only to make us aware of technical issues or urgent matters and not to make general statements or comments. I remind members of the constitutional requirement to be physically present within the confines of the Leinster House complex in order to participate in public meetings. I cannot permit a member to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any members partaking via Teams to make us aware they are on the grounds of the Leinster House campus.

In advance of inviting the witnesses to deliver their opening statements, I will advise them of the following in relation to parliamentary privilege. Witnesses participating from the committee room are reminded of the longstanding parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction.

There will be a five-minute slot for opening statements per group, which will be followed by questions from members of the committee. We will start with Mr. Tomás Ó Ruairc from the Department of Education.

Mr. Tomás Ó Ruairc

I thank the Cathaoirleach and the members of the committee for the invitation to discuss the important issue of the challenges facing refugee and migrant children in Ireland. We are joined today by my colleague from the Department of Education, senior inspector, Ms Linda Ramsbottom.

The numbers of refugees arriving in Ireland, both from Ukraine and from other countries, is at an all-time high. As of the end of May 2023, just over 15,500 Ukrainian pupils had been enrolled in primary and post-primary schools across Ireland. The Department of Education also receives a monthly overall figure for the number of children enrolled in schools that are residing in international protection accommodation from the Department of Children, Equality, Disability, Integration and Youth. At the end of May 2023, the Department reported that there are just over 2,800 children enrolled in schools that are living in International Protection Accommodation Services, IPAS, settings.

The Department of Education is committed to delivering an education system that is of the highest quality, and where every child and young person feels valued and is actively supported and nurtured to reach their full potential. Refugee and migrant children in our schools have faced enormous challenges in their lives and are one of the most vulnerable groups of children in Ireland. I will speak about the supports and strategies that have been developed to support refugee and migrant children in the Irish education system.

The Migrant Integration Strategy, which was published in 2017, sets out the Government’s commitment to the promotion of migrant integration as a key part of Ireland’s renewal and as an underpinning principle of Irish society. A key element of the strategy’s vision is for migrants, and particularly their children, to benefit fully from the education system. Actions that are relevant to this Department under that strategy continue to be progressed and the Department will continue to engage with the Department of Children, Equality, Disability, Integration and Youth, which has responsibility for the strategy, to support arriving families.

Regional education and language teams, REALT, were established to support existing structures in responding to the needs of Ukrainian and international protection, IP, applicant children accessing education. Their primary role is to assist in allocating children to school places and to support schools in meeting the needs of children as they arise.

Children and young people learning English as an additional language, EAL, require well-planned support tailored to meet their individual language needs in order to participate fully in school life and to derive maximum benefit from their education. The Department provides specific English language support to schools with pupils newly arrived into the country who have English as an additional language need. Schools may also apply for further language support through the staffing appeals process. At this point in time, the Department has allocated almost 2,000 posts in total to schools for EAL purposes.

In addition to EAL supports, it is estimated that almost 600 mainstream posts have either been newly allocated or retained in schools due to increased numbers of new Ukrainian arrivals. In August 2022, due to the rapidly increasing arrival of Ukrainian refugees, additional temporary special education supports were put in place to support schools with large enrolments. Schools where ten or more Ukrainian pupils are enrolled are provided with additional special education teaching, SET, resources. Schools with 15 or more Ukrainian pupils are provided with additional special needs assistants, SNAs. The process has worked very well, and a total of almost 550 schools received additional temporary SET hours and almost 330 received additional temporary SNA supports. The same level of resources are available under a separate process to support schools who have enrolled a significant number of international protection children.

The Department provides a wide range of supports to all schools to support the inclusion of all students and to address barriers to students achieving their potential. Supplementing the universal supports available to all schools, the Delivering Equality of Opportunity in Schools, DEIS, programme is a key policy initiative of the Department to address concentrated educational disadvantage at school level in a targeted and equitable way across the primary and post-primary sector. In March last year, the Minister for Education, Deputy Foley, announced the single largest expansion of the DEIS programme. This benefited 361 schools. The programme now includes 1,200 schools and supports approximately 240,000 students. This means that one in four of all students is now supported in the programme. The refined DEIS identification model includes a component to reflect the level of educational disadvantage experienced by students who reside in International Protection Accommodation Services centres or emergency orientation and reception centres, EROC.

There is a strong focus on education in the Department's new national action plan against racism and the implementation plan, which was published by the Minister of State, Deputy Joe O’Brien, in March of this year. The Department of Education will continue to progress the actions to strengthen inclusion and anti-racism at all levels of the education system.

Child migrants can face challenges relating to personal, physical and emotional safety. The well-being of children is at the core of all that we do in the education system. Supporting well-being allows children to feel safe and happy in school and to learn. We are lucky that our schools provide a caring and supportive environment where children can flourish. Guidance counsellors support refugee and migrant children in post-primary schools in terms of personal and social development, educational development and career development. This could include, for example, information on what stage of the system would be appropriate for children to enter to continue their education in Ireland, information on grants, subject choice and entry requirements to institutions and career guidance information.

The National Education Psychology Service, NEPS, continues to gather information on the Ukrainian and other refugee experiences through interaction with their psychologists working in schools, attendance at REALT meetings and keeping up to date with national and international research.

In conclusion, I thank the committee for the invitation to attend today and to provide an update on the actions being taken by the Department of Education to support refugee and migrant children to overcome the challenges they face. I look forward to questions.

An Cathaoirleach

I thank Mr. Ó Ruairc. I know there were some other points there that he did not get to raise. However, they are in his statement, which we have, so they will be on the record. I thank him. I will now move to Ms Kate Duggan from Tusla.

Ms Kate Duggan

I thank the Cathaoirleach and members of the committee for the invitation to appear before it today. I am joined by Ms Clare Murphy, national director of services and integration, and Ms Lorna Kavanagh, area manager, national services and integration. Refugee and migrant children are one of the most vulnerable groups of children in Ireland. Whether in care, accommodated by the State, or settled with their families, they face a broad range of challenges such as housing, health, education, community integration, reunification and risk of exploitation or trafficking. Tusla supports children and young people living with their parents in International Protection or emergency reception centres, separated children who are being cared for by adults who are not their legal guardians, and unaccompanied minors.

Tusla, together with our partners in the community and voluntary sector, provides support to these children who are living with their parents in international protection and emergency reception centres. This includes family support, service signposting, information and advice; access to preschool supports; school placement and after-school services; resettlement programmes; and needs assessment. Our area managers communicate with centre managers to ensure the centres are clear on referral pathways for Tusla where a child protection concern may arise. Tusla also provides core operational leadership at national and local level to lead and co-ordinate the 27 children and young person services committees.

Tusla and the Children's Rights Alliance are jointly commissioning research into identifying integrated family support approaches for families living in the international protection accommodation system to inform how we can better support them. I acknowledge our staff and our partners in the community and voluntary sector for their agility and hard work in responding to meet the needs of these children and families. However, as the numbers increase we will be further challenged to respond in a timely and accessible way within existing resources.

Separated children seeking international protection and unaccompanied minors are children under 18 years of age who present in Ireland from their country of origin who may need international protection and are separated from their parents or their legal or customary caregiver. Many of these young people may have high levels of vulnerability and-or have experienced significant trauma. They require access to various State services. The problems and challenges they may face include separation from family and friends, bereavement, social isolation, language barriers, emotional and mental health problems, discrimination, racism and uncertainty around their future. However, this is not an homogenous group of young people. Many of the young people who arrive in Ireland are aged between 16 and 18 years and are in search of accommodation, access to education or employment and reunification with their families. Each of their needs can be different.

Tusla's team that works with separated children seeking international protection delivers its service from the point when a child is identified by Department of Justice immigration officials as a potential separated child seeking international protection or an unaccompanied minor. This dedicated team undertakes an assessment which informs care planning, placement allocation and, where eligible, access to aftercare. Our team also supports these young people with the reunification process in the absence of a clear mandate to undertake same.

Over the past 12 months, there has been a significant and unprecedented increase in the numbers presenting to or being referred to this service. This has significantly impacted our ability to respond appropriately. In response to this we have scaled up services through increasing staffing levels and the number of placements. Despite our efforts, we are acutely aware of the increasing pressure on our services and the impact this can have on children and young people.

Several key challenges are impacting our ability to respond effectively. These include the unprecedented demand for this service in a relatively short period of time, a shortage of appropriate care placements in the context of an overall placement crisis, the challenges around availability of suitably qualified staff and the need to expand the authorised worker role supporting these young people. The challenges also include the need for legislative changes or policy direction on the provision of care and accommodation for separated children and unaccompanied minors, the need for a review of the transition to adult services and the right to aftercare services. There is also a need for a review of the reunification process and clear roles and responsibilities should be set out in this regard.

As an agency, our internal audit system has identified significant challenges in standards of governance, documentation, placement, communication and legal matters for this service. We have a service-wide improvement plan in place to address this. However, this remains challenging in the context I have outlined. We are highlighting these challenges today because, ultimately, they can have an impact on the young people who use our service.

We have also undertaken many proactive initiatives. These include collaboration with child advocacy organisations and NGOs on the development for Tusla of a revised intake and eligibility process for separated children seeking international protection. This would include access to advocacy and a review process. We have a partnership with MECPATHS to raise awareness and provide training to staff on child trafficking in Ireland. We have implemented the 2021 child sexual exploitation procedure in partnership with An Garda Síochána. We have also developed a bespoke learning and development training programme to train our front-line staff.

It is also important to note that many of the young people being accommodated by, or in the care of, Tusla have integrated very well, are accessing education and employment, and are engaging in sports and social activities. Many have reunited with their families. As an agency, we are determined to do everything we can to ensure this vulnerable group of children and young people access safe and appropriate services. To do so will require timely and definite legal and policy changes, significant interagency co-operation, and an increase in the resources available to respond to these referrals.

We have engaged with the Department of Children, Equality, Disability, Integration and Youth and the Children’s Rights Alliance to plan an engagement with stakeholders in the wider sector to consult on how we could better structure and deliver services to separated children seeking international protection and unaccompanied minors. We will also be engaging with young people who have accessed our services to hear directly what their experiences have been and how they think we can improve services to better meet their needs.

Ms Sharon Mpofu

I thank the committee for welcoming MASI to this session. During the recent World Refugee Day celebrations we conveyed important messages to the Minister, Deputy Helen McEntee, regarding improvements to the international protection application processes in Ireland. We proposed granting stamp 4 status to applicants who have been in the system for more than two years. We also proposed re-evaluating the classification of certain countries as safe countries of origin. We called for immediate working rights, or a full weekly allowance, for applicants who are unable to secure accommodation as well as the end of the direct provision system which we believe dehumanises asylum seekers. The stringent measures in direct provision centres strip people of their dignity and impede the freedom of young individuals.

Additionally, in all our messages the housing crisis faced by asylum seekers, which results in homelessness, was highlighted as an urgent issue requiring comprehensive action. We raised concerns about inequality in the treatment of refugees from different nationalities, citing a significant contrast in resource allocation and access to welfare. This poses a significant challenge for refugees in Ireland. MASI is concerned about the approach that IPAS has taken to evict from centres people who have permission to stay in the country, especially families and children. This has caused a lot of distress for people, especially with the challenges they face in obtaining houses.

We appreciate the effort the Department has made in obtaining accommodation for the stranded men who ended up living in tents. We were wondering whether the Minister could comment on plans to prevent this from happening moving forward. We are concerned about reports from people with disabilities living in direct provision who are sometimes not taken into account when IPAS staff deal with them as far as their needs are concerned. I thank the committee.

Dr. Fiona O'Reilly

I thank the committee for the invitation to appear before it. I am joined by Dr. Alva O’Dalaigh. Safetynet is a medical charity providing quality health care to vulnerable patients without access to mainstream services. At the same time, we advocate for an inclusive health system for all. Safetynet's services are commissioned by HSE social inclusion and, in the national transit centre, by HSE health and well-being. We provide primary care services, including GP and nursing clinics and health assessments and screening.

Over the past year and a half our migrant health service has increased significantly. Initially we provided pop-up clinics for beneficiaries of temporary protection fleeing the war in Ukraine and the increased numbers of international protection applicants. Now, our migrant clinics mainly see international protection applicants who are faced with more structural barriers to care. We continue to provide GP clinics for Roma without medical cards.

Of the 6,500 beneficiaries of temporary protection, BOTPs, and international protection applicants, IPAs, from more than 85 countries seen by our migrant health service last year, 800 were children. This year so far, we have seen almost 800 migrant children in our clinics.

I will now talk about the main challenges facing refugee and migrant children, seeing this through the health lens and understanding it in the broad social determinants of health model. The first and quite a new challenge that we have seen is children or young people on their own being deemed adults and therefore not being protected. These age-disputed minors present to us as children. However, the State may not recognise them as such. While they are deemed adult, they are not protected as children as they should be in accordance with international, EU and national law. Often, these minors are not able to provide documentary evidence of age at the time of their initial assessment. It can take months for a reassessment, after which their child status may be accepted. In the interim, they can be extremely vulnerable - as those we have come in contact with have been - and unprotected and placed in adult accommodation. At least one of our 17-year-old patients in this situation was given no accommodation and slept on the streets. Later, his reassessment of age was accepted and he was taken into care.

In the briefing document Safetynet submitted to the committee, we describe eight case studies of young people between the ages of 15 and 17 placed in adult accommodation. The GPs engaging with these people concurred that they were likely to be the ages they claimed to be based on their physical and behavioural maturity. All minors requested a reassessment and waited months for one, and most of those with whom we have been in contact recently are still waiting. The two 15-year-olds - one of whom was 14 when she came here - continue to be very vulnerable, with one not managing to feed herself adequately and the other’s mental health suffering. Common themes emerging from the conversations with these young people are the lack of information they receive about the process, the lack of certainty about whether they have been age-assessed, the desire to go to school, the desire to be among their own age group and their feelings of fear and anxiety.

It is our understanding that the International Protection Office relies on the eligibility for services assessments done by Tusla to decide whether to treat the young person as a child or an adult. However, Tusla has separately been clear to us that its assessment should not be used for this purpose. The principle of benefit of doubt in favour of the child’s age does not appear to currently apply. At the very least, we believe that in the interest of child protection, the young person should be placed in safe accommodation until the age assessment has been fully concluded, including the appeal. We welcome the provision in the new Tusla protocol stating that benefit of the doubt will apply and we recommend this be implemented immediately.

I will touch on other barriers because I know some of my colleagues and Dr. Walsh will expand further. The barrier to health integration is significant. Migrant children require access to primary care 24-7, just like Irish children. Importantly, they require immunisations to protect them against disease and often catch-up immunisations. Community healthcare organisations, CHOs, have set up vaccinations, which vary across the CHOs. The medical card application process is slow and does not cater for parents of migrant children with low or no income who cannot provide evidence either of means or no means. Migrant children, including migrants from the Roma community, have been here for years and still do not have access to mainstream medical care. The lack of communication ability, particularly interpreting, is a serious barrier. Unlike the rapid establishment of Ukrainian interpreting, access to interpreting in other languages is still not available as a standard for primary care across CHOs.

There is also a lack of system-wide co-ordination and communication. Migrant families are not given any notice, or 24-hour notice, when they will be moved. Their public health nurses are not told when newcomers are coming into the area and they are not told when they will be moved out of the area, so it is difficult to co-ordinate care. In addition, poverty, inappropriate accommodation, inappropriate food and the impact of cramped living conditions without cooking facilities have been well described and are a constant barrier and challenge for children's physical, mental and emotional well-being.

In conclusion, migration in and of itself imposes challenges for children, including loss, trauma and fear. The State's response to migration and efforts to welcome, accommodate and integrate children and their families can create or remove further challenges. Some migrant children are in Ireland for years and still do not have access to mainstream health services. We saw through Covid and the response to the Ukrainian crisis just how quickly the health system can respond when there is a will and an urgency. A co-ordinated emergency response approach is required when usual systems cannot cope any longer to ensure people receive safe shelter and have basic needs met, including healthcare. Children should always be prioritised within this response. We should never again be in a situation whereby people and, on occasion, unaccompanied minors applying for international protection are forced to sleep on the streets.

Dr. Aoibhinn Walsh

I thank the Chair, clerk and members of the committee for inviting me to speak. I am a consultant general paediatrician with a special interest in inclusion health working for Children’s Health Ireland, CHI, and I am responsible for The Lynn Clinic, which is a community outreach clinic for children experiencing social exclusion. I provide healthcare for many marginalised groups, including but not limited to marginalised migrant children, such as international protection applicants, refugees, Ukrainian beneficiaries of temporary protection and Roma children. Unfortunately, I am the only such paediatrician with a somewhat resourced, temporarily-funded team to be able to provide this dedicated, holistic and much-needed service at present in Ireland, though many colleagues daily go above and beyond to try to address the challenges I will now outline. I will use the term “migrant children” throughout to refer to marginalised migrant children in need of an inclusion health approach and equitable healthcare access.

Migrant children attending our outreach clinic are presenting with serious medical problems that are a direct result of or exacerbated by their adverse social determinants of health. These children and families require culturally competent, trauma-informed care that our health service is ill-equipped to provide. For an individual child, migrant status can mean difficulty obtaining necessary medications in the absence of a medical card and high risk of being lost to follow-up as they are relocated, often multiple times, between different healthcare regions. Due to language and literacy barriers, their caregivers can have difficulty with understanding and being understood. Many doctors use Google Translate or equivalents when no other alternative is readily available. However, this is not conducive to a comprehensive and accurate consultation but, rather, one that makes do inadequately and unfairly.

On a population health level, it means migrant children have lower population vaccination rates, there is not yet a formal catch-up vaccination programme in place nationally and there is a lack of standard public health developmental checks and interventions. Due to staffing shortages, many infants I have met have no public health nurses. I have encountered very poor population nutrition with preventable nutritional deficiencies which, untreated, can have irreversible impacts on growth and cognition, including rickets and anaemia. At every clinic, we encounter severe dental decay and malnutrition in the forms of impaired growth or obesity that is then compounded by food insecurity and lack of adequate cooking facilities. Overcrowded accommodation directly results in increased screen times, disordered and disrupted sleep, lack of space for physical exercise, as well as limited normal play and development opportunities.

For migrant children with neurodisability and neurodiversity, our current system of support and diagnosis assumes a certain level of caregiver education and familiarity with the English language. Filling out the forms for access to disability services is a task our team takes on for many of the children under our care as it has proven impossible for the caregiver to convey their children’s significant and sometimes crisis needs without informed assistance.

These children who are living in confined, overcrowded spaces experience rapid escalation in challenging behaviours with worsening food aversions, physical aggression and self-injurious behaviours and no recourse for support.

The circumstances of disputed minors is opaque, very difficult to navigate for healthcare providers and has left children in the most appalling high risk situations that Dr. O'Reilly has outlined. Health professionals who come across these disputed minors are uncertain of their role, unclear as to pathways of advocacy and support and often are unable to provide necessary medical care. Greater transparency is needed into the process of how those declaring themselves children seeking international protection on arrival to our State are then deemed as adults by what seems to be an arbitrary and brief decision-making process that can have serious ramifications across all aspects of their lives.

We also must recognise that migrant children have experienced multiple adverse childhood events that will have lifelong impacts on their health and well-being. These children in time will become parents themselves, perpetuating an intergenerational cycle of deprivation, poverty and adverse health outcomes.

A proactive preventative inclusion health approach in our paediatric hospitals that supports early recognition of medical issues, comprehensive assessments and feasible management plans is essential to be able to meet the complex bio-psychosocial needs of these children and families. Time and space are needed as often much more is disclosed and diagnosed than what was originally felt to be the issue. Strong links with local community providers of healthcare enables integrated care. Our outreach clinic links regularly with many such local organisations, for example, Safetynet, Baleskin Reception Centre, the national transit hub, the HSE homeless healthlink team, international protection accommodation services, TUSLA and HSE dentistry, to ensure management plans are carried out effectively. We have also forged links with many community support organisations, as often identifying the medical issues is the easy piece and it is signposting towards freely available resources that can aid with their social, psychological and fiscal needs that proves the challenge.

Busy oversubscribed acute hospital infrastructure does not have the capacity, staff or resources to adequately meet the complex needs of these children and families but failing to address and meet their health needs perpetuates the cycle of deprivation that they have been trapped in. These children have experienced enough trauma and they deserve to be given the best chance at improving their lives.

I thank the committee for its attention and now welcome members' questions on how we can address these challenges facing the most vulnerable children in Irish society. Gabhaim buíochas leo.

An Cathaoirleach

I thank Dr. Walsh. I thank all of the witnesses for their statements, which contain a huge amount of information, as well as for the additional information we were given as well.

I will go through the speaking list for the members. Because we have so many witnesses, if witnesses want to reply to a question they can indicate and I will call them. First, we have Senator Ruane, then Deputy Costello, then Senator McGreehan who is online and then Deputy Brady. Senator Ruane is first.

Senator Lynn Ruane

I thank everyone for their presentations. I will hone in a little, because we will probably have a second round, for the first round on the age-disputed minors and the idea of the benefit-of-doubt principle. I have some idea of the direction in which it goes. The International Protection Office, IPO, holds up the determination that it is disputed whether somebody is a child. As far as I understand it, the IPO states that Tusla makes that age assessment. What I am wondering is, what is involved in that age assessment? I would also like to know how often it happens and if there are statistics on how often it has resulted in a minor not having access to what he or she needs. My first question is on how that assessment is determined.

Is the move to the benefit-of-doubt principle something that is already happening? It does not seem like much needs to happen for it to happen, other than saying it is happening. If someone is saying that we are moving in this direction, what is stopping that form being today? Does the IPO then also accept and work off that principle of benefit-of-doubt? Has it to run through each one, not only Tusla? Has there to be agreement with the IPO in order that it does not assert something else as well? What has happened to date?

Perhaps Safetynet could pick up on what are the vulnerabilities for minors who have been left in that. Obviously, there is education, which has been spoken about but surely there is a myriad of other complexities of a minor being left, seen or deemed to potentially be an adult. Even beyond the accommodation piece, is there a difference between how quickly you can access healthcare depending on whether you are 17 or 18? I would say that is arbitrary anyway. We definitely should be extending the definition of "minors" beyond that 18 years bracket, in terms of coming into a country. In terms of care, there is not much difference between an 18-year-old and a 17-year-old. What are the vulnerabilities and what are the issues that have arisen for minors? An appeals system was mentioned and things can take time. If somebody does not have documentation to prove it, obviously it can take time before that documentation is sent from the country from which somebody has come. How long has that delay been for young people?

Those questions in relation to that age assessment are for Tusla and Safetynet.

Ms Kate Duggan

I will give the Senator a high-level overview and then, if she wants, some more detail around the actual age assessment process. Obviously, referrals come to us from immigration officials where they believe a child should to be referred to Tusla because they have a concern that he or she is a minor. They come to us and we undertake our eligibility protocol for access to childcare services to inform his or her care planning.

There have been 220 young people referred to us in the year to date and 72 of those young people were from Ukraine. As of Sunday night, we had 256 young people in the care of or being accommodated by Tusla. Certainly, with the increase in the numbers over the past number of months, we have worked with the IPO. We have collaborated with the IPO, with the Children's Rights Alliance and with the NGO sector, such as the Jesuit refugee council, on our eligibility assessment and our eligibility for childcare services. We have refined that this year. That is now implemented. Our staff have been trained.

The three key principles that we have brought into that include the benefit-of-doubt principle in terms of minors but I want to flag for the committee that there is also a risk to that of adults being placed with minors. We are very aware of the risk of minors being placed in adult services, which is not something we want, but equally, we have a risk of adults being placed in with minors and there is the risk attached to that. We certainly mitigate that, in the case of young people where there is concern about their age and where we are not fully assured about their age, through us placing them in temporary accommodation arrangements away from minors.

The second change to that is the right to advocacy. We now are working with the Youth Advocacy Project, YAP, in terms of the right to advocacy for all young people who are undergoing the eligibility assessment. The third is that we now have a review panel. This is where we have individuals who are separate to our assessment team. Where there is a review, the young person can appeal that decision to an external panel.

However, where we believe, through our detailed assessment, the individual not to be a minor, he or she is then referred back to the immigration officials.

Senator Lynn Ruane

What is involved? I am wondering what the assessment team makes of it.

Ms Kate Duggan

I will let my colleague, Ms Kavanagh, talk the Senator through that.

Ms Lorna Kavanagh

It is a general intake assessment. If, during the course of that intake assessment, it appears to us that there is a concern in relation to the age of the young person, we suspend the assessment to allow the young person to seek advice and to get an advocate. That is in recognition of what the Senator was saying - the serious implications of determining somebody to be an adult if he or she is, in fact, a minor. We suspend the assessment for the young person to seek advice and to get an advocate, which we have sourced for him or her, and then they re-present and we proceed with the assessment.

The assessment, basically, looks at their story in relation to their family structure - who is in their family, what their journey was to the country, what their level of functioning is and whether they have any dependants in their country of origin. We try not to arrive at a conclusion based on any one aspect of that. If there is supporting documentation from professionals in the international protection accommodation services , IPAS, or Safetynet, for example, we have had some submissions from doctors, all of that is taken in the round.

This is not an exact science. Other member states use medical assessments. That is not the course of action here in Ireland. It is cautioned against because of the two-year margin of error for conducting medical assessments on young people presenting as minors. It is a social history account from the young person and, as I say, not an exact science. Based on that interview and assessment, with the advocate and young person in the room, a decision is arrived at on whether we believe the young person is, in fact, an adult.

Senator Lynn Ruane

I am struggling a little with regard to a social history. First, culturally, people's social histories can be so complex and traumatic that they appear as adults well before their time with regard to the things they have endured and experienced. From where has the mechanism that determines this is the best way to do it come? I had a child at 15. What if I fled to a country and said I had a child and done this and that?

Ms Lorna Kavanagh

We undertook extensive consultation on it and drew largely on the European Asylum Support Office, EASO, guidelines on conducting age assessments. It is important to say that the provision in legislation for conducting age assessment is not actually with Tusla but under the International Protection Act. When a child is referred to us under section 13, where we believe the young person to be a minor, we look at eligibility and what standard of care or care placement the young person needs. We drew heavily on the EASO guidelines and consulted the NGOs in the sector. It also went through robust legal processes with the council. We have arrived at a position which is much better than where we were before, where assessments were conducted based on what was obviously apparent. We were saying that people appeared to be adults and so they were not accepted into our service. That obviously is not happening any more. It is much more comprehensive but it is absolutely not straightforward.

One has to consider everything in the round. Some people have straightforward accounts of their experience. Other young people are traumatised and are not able to communicate what their experience has been. We have also come across situations where young people present and are extremely vulnerable but they are not necessarily minors. Sometimes there is paperwork that the International Protection Office has access to if the young people have been in other member states, such as Sweden or elsewhere, where age assessments and medical assessments have been undertaken. We seek that information. Immigration services also have information on visa applications. Sometimes that can determine that young people are not minors. We have a number of young people in our care who we believe are adults but we have given them the benefit of the doubt. They present saying they are 15. A year or two passes and we think they are older than that, but we have a duty of care to see that through, which we are doing at the moment. We have to be careful about our safeguarding responsibilities towards other children.

The benefit of the doubt is not a point or decision-making piece. We are training our staff to understand that they must apply the benefit of the doubt from the outset. Young people are referred as children and, from the outset, are to be treated as children, unless something suggests to us that they are not children. Either way, the benefit of the doubt is applied throughout the process. A number of young people have been re-referred with additional paperwork which they got from home or elsewhere. When they present to us with that paperwork, we reassess them. There are times, when conducting those assessments, that there is significant pressure on the system. We have taken a number of young people into care on the benefit of the doubt, where we initially believed they were not minors and then they came with additional information or supporting documentation that would suggest that they were.

We cannot validate documentation in Tusla. We rely on our colleagues in the IPO to validate documentation. If Afghan young people present with tazkiras, the IPO may say it accepts them as identification, but if it cannot validate them as authentic identification, that can create problems for us. Often, the nature of the circumstances of the young people is such that they may not have original documentation and could have copies or photocopies of it. It is quite complex. There are certainly much fairer procedures and due process in our new procedure than there were previously. That is just to provide that assurance.

Dr. Fiona O'Reilly

I will comment on our experiences of all that through the children and young people whom we meet. Dr. O'Dalaigh will then give the Senator an idea of the vulnerabilities she is asking about. It is certainly complex, as our colleague from Tusla said. There is a difference between complexity and lack of clarity or transparency. Just to say from the start, there is no doubt that the new document governing this process, which is from March this year, is definitely a move in the right direction and talks about providing for the benefit of the doubt. However, our experience of the age assessment, eligibility assessment or the situation that migrant children who come to the doctor and claim to be a child are in, what they go through and what they understand, is not acceptable and has not been over the last year. If the benefit of the doubt was given to these children, it would not be possible to put people into adult accommodation after deeming them adults and then, eight months later, take them into care because they have been deemed children. If the benefit of the doubt was given right through the appeals process and the assessment, then they should not be put into adult accommodation until after the reassessment.

I understand that Tusla has a responsibility to safeguard other children. The fear is that it would put somebody who is potentially an adult into schools or in with children who are obviously not adults. However, I do not think it has to be black and white. There can be safe accommodation for young people in the process if the process is seen as something more than a once-off or something that happens in 24 hours. One of the things that contributes to the lack of clarity is the fact that, as the Senator said, the age assessment provision is not with Tusla but with the IPO. Therefore, the IPO is using something which Tusla says should not be used for age determination. Based on that, children are being put in risky situations with adults. We accept that while the provision is not with the organisation, what the organisation is actually providing involves making the determination. Who is responsible? That is a big problem.

The children with whom we are still connected, speaking to and being doctors for are waiting for an assessment or reassessment because their papers may have come or they may have resubmitted them. They are in adult accommodation. We have fears and concerns for them. We do what we do when the Children First training tells us to report it on the Tusla portal, but then we are told not to do so for these children because they are not deemed adults based on an assessment that should not have been done by Tusla but is being done by Tusla. In the narratives of our children, they are confused and we are confused. Where are their advocates? I ask Dr. O'Dalaigh to talk about some of the cases of vulnerability.

Dr. Alva O'Dalaigh

I just picked out a few cases. We have seen quite a few children this year. We interview the unaccompanied minors through translators. We had one girl who was just ten days short of being 15 when she arrived in Ireland. She has been in adult accommodation since she arrived ten months ago.

When she was met a month after her arrival, she said that she found it hard to look after herself, that people were drinking in the accommodation and she found that intimidating. At that time, the GP said it was evident from the consultation that she did not have the maturity of an adult and it was not suitable for her to be deemed an adult. She was seen by two other GPs for minor medical issues and again according to their notes, they wrote letters stating that they felt she had been inappropriately aged because of the way she presents herself as regards maturity. We recently caught up with her. She had been placed in self-catering accommodation which meant she got an additional allowance to buy food and cook for herself rather than food being cooked for her. However, she did not feel her English was up to it and she felt intimidated about going to Lidl, the local shop, to buy her food. Therefore she was not eating in her accommodation. The Jesuit Refugee Service placed her in Youthreach. She goes there Mondays to Fridays to learn English and they have a hot meal in the middle of the day, so that is what she is eating. She said that everyone else in her accommodation is an adult. No one else is her age and some people had prevailed upon her to give them some of her money, which she felt she had to do. I suppose she did not feel she could stand up for herself. One of her teeth was in need of dental attention. She said she had been crying about it in her room and no one paid her attention. She shares a room with two adult women. Eventually one of them called the manager of the accommodation who brought her some paracetamol but that was the extent of the care. She had a GP but had received a letter telling her she had been assigned and asking her come and to bring someone to translate for her. She said she did not have anyone who could translate for her and also did not know where the GP practice was so she did not go. She has now been in that situation for ten months and is still 15.

An Cathaoirleach

I will have to move on as a number of people still have to ask question. It is possible that we will have a second round and be able to come back to Senator Ruane.

Deputy Patrick Costello

I will start by making a general point. Plenty of people are pushing a myth that our services are somehow excellent and are simply overburdened because we have let too many people into this country. That is a falsehood that is ultimately rooted in racism. That certainly came through in some of what we heard today about the lack of care placements and staff. This is not the first time it has been said to us about Tusla and social work services. The lack of public health nurses, PHNs, impacts on every community in every way. Based on some quick googling, the figure given by the Department of Education for the number of children from the International Protection Accommodation Services, IPAS, who are in schools here is less than 0.5 % so this idea that Ireland is somehow full is nonsense. Some of the statements today have helped to expose that. It is important that we underline that, push back against it and point out that economic decisions about how and where we invest in public services are causing these challenges. This is not to say that there are no additional needs or vulnerabilities. As Safetynet Primary Care stated, migration in and of itself presents challenges, grief and loss so there are additional vulnerabilities of which we must be aware. I wanted to underline that.

One of the additional vulnerabilities relates to the cultural competence of service providers, the challenge of needing translators and the lack of translators in our health service, courts service and all over the place. I want to dig into this idea of cultural competence. Akina Dada wa Africa, AkiDwA, produced a report about the experience of African families dealing with Tusla and being parents of children in care. We could get into a discussion about parents needing additional support, as we often do, but I want to focus on cultural competence. What are those at the top of Tusla and the Department of Education doing to ensure and support it so that, at the very least, the vulnerability that arises from the lack of translation services and the lack of understanding can be overcome?

My next question is for the other witnesses, if there is time. They see this. They mentioned that different CHOs work in different ways. They are on the receiving end of this. Can they highlight good practice in the area of cultural competence that we could highlight and encourage?

Mr. Tomás Ó Ruairc

In the first instance, standards are stitched into initial teacher education as regards the importance of inclusion, in the broader sense, and cultural and linguistic awareness. Furthermore, the National Educational Psychological Service, NEPS, and the Professional Development Service for Teachers, PDST, which is due to be reconfigured as Oide - it will be a new overall service - provide a suite of resources. For example, since the immediate outbreak of the war in Ukraine, and also more broadly, there is a repository of information and continuing professional development, CPD, resources for schoolteachers on Scoilnet.ie. Those resources cover English as an additional language, EAL, which I referred to earlier, and intercultural and curriculum supports developed by those services, including not only the PDST but also the National Council for Curriculum and Assessment and the education and training board, ETB, sector. We recognised a need at the outset for facilities in Ukrainian. There are digital tools for translation which are quite effective. In the area of special educational needs, one of the early challenges we identified was that Ukrainian parents had reports from Ukraine but they were not in English. The National Council for Special Education, NCSE, now provides a service to translate those reports to assist in the assessment of need process. At post-primary level, the PDST is running leading language support and team teaching for inclusion seminars again in term 1 of next year and provides school support for EAL on an ongoing basis. They are a range of some of the supports provided in that space.

Ms Kate Duggan

In the context of separated children seeking international protection, who we spoke about, the first thing for Tusla has been access to and recognition of the need for translation services and advocacy. It is also important that in the recruitment of the workforce for separated children seeking international protection, we have sought to have multicultural teams. We have employees from Zimbabwe, Ukraine and South Africa. It was important to us to have a multicultural workforce. We have worked with the Ombudsman for Children's office in the past few years on the provision of services in international protection and the development of an intercultural strategy. We are looking at staff being aware of intercultural issues and cultural differences and responding to them, especially as regards family support in child protection and welfare services and being able to promote cultural awareness and diversity training with staff across our front-line services, not only in the provision of services to those seeking international protection.

An Cathaoirleach

Does anyone else want to come in on that question?

Dr. Fiona O'Reilly

I am conscious I have spoken already so I will be quick. I totally agree with the Deputy's point about excellent services. We are not doing the basics. It is not numbers. By that I mean that Safetynet Primary Care provides a much needed health service for Roma families from the back of a van in a car park in this day and age and it is much needed. We do that once every two weeks. Why is it needed? Roma families should have doctors and medical cards and they do not. We are not getting a lot of the basics right. I agree with that point.

We can go as far as we like on cultural competence and we should go very far, but we cannot go anywhere if we cannot speak to people. Our State services do not have the ability to speak to people because they do not have access to interpreting. There is no standard interpreting service for primary care. That was set up overnight in response to the Ukrainian crisis. Now any Ukrainian who comes in to a GP can get a Ukrainian or Russian interpreter on the phone. However, people from Somalia or Uganda are either told, like the girl Dr. O'Dalaigh spoke about, they should find someone to bring with them or the GP will give bad care by using Google Translate. It is dangerous care.

It is not that translators do not exist. There is a brilliant online interpreting service that we use all of the time called LanguageLine Solutions. It is just money. It is just about resources and making that accessible and available. It could be done tomorrow if the will was there.

Dr. Aoibhinn Walsh

I completely agree that resource constraints that are national impact all children. Is it is about knowing the context as to when to configure resources around the additional needs and barriers of these children. For example, when children are referred to us we give them an hour with face-to-face interpreters, where possible. These children will come to us having been referred from an accident and emergency department where they may have presented at 3 a.m. with a parent to speaks with a dialect from Malawi, with rudimentary translation done by phone. At least the accident and emergency department staff know that they can try to address the immediate issue at hand and that there is a backup then to address the needs in a more holistic manner. From a health perspective, we need to know that the people engaging with these children know the questions to ask as well. There is a piece of training on this that we are trying to bring about more nationally through the Royal College of Physicians in Ireland, RCPI. It is really about knowing that we cannot do everything for every child all of the time but that if somebody meets a child and knows it is not within his or her remit, timeframe or skill set to be able to manage what can be such a complex level of need in the case of disputed minors, for example, or if a child clearly presents with significant educational needs and has not been linked in with the appropriate services, that person knows somewhere the child can go to, to be able to obtain services for those needs in a much more structured and cohesive fashion. This impacts on resource usage for other children if these children do not engage with hospital services and if they do not attend an appointment. For example, if there is an appointment for an MRI of the brain under general anaesthetic, this uses a huge amount of hospital resources in terms of specialists, equipment and reporting time. If the person has relocated, did not get the appointment time and does not attend, then all of that is gone. If such people had cancelled, if we knew they had been relocated and were able to book them back a month later, that appointment could then be given to another child. It impacts resource usage for every single child nationally.

Mr. Tomás Ó Ruairc

On a point of information, there is a migrant teacher project which the Deputy may be aware of in the Marino Institute of Education. It has a network of more than 2,000 teachers who qualified abroad. The project runs a bridging programme for those teachers from the point of registration into employment. Obviously, there is cultural competence at their fingertips, as they are natives of these other countries. Really impressive work is being done there. More than 220 teachers across four cohorts have been through that bridging programme. There is another course on cultural competence in the community context. We have used a model in our consultation on the statement of strategy called BEACONS, that is, bringing education alive for our communities on a national scale. We did a sample exercise as part of an OECD project with the community in Youghal where Ukrainian parents and children were brought together with teachers and parents at the same time to look at the issues they were facing in education, as well as their opportunities, to try, in a community context, to broaden the cultural competence as well.

Ms Sharon Mpofu

With regard to integrating, I believe there is really a vast gap in the sense that the IPO has a certain structure whereby if a person coming from a different country needs an interpreter, he or she can get one, whereas it is different with the GPs and healthcare. Of late, at the end of last year, the University of Limerick started a course as a pilot project in which it was training medical interpreters in medical communication and interpreting in the healthcare system. I was one of the students who took up that course. After that, in the follow-up, perhaps a person could be aligned or associated with a certain GP network in order that if the GPs know they need certain interpreters, they can find them at a certain place and time. There is a real difference in cultural competency. We come from different cultural places. For example, perhaps a female cannot converse with a male, or a male cannot converse with a female and they will not be open when it comes to medical issues because they are very sensitive issues, whereas other people may be free to do that. For us coming from the international protection background, we are also on the receiving end of some of the challenges that have been facing the system. It becomes quite a health challenge for people who do not have English as a second language to communicate. As Dr. O'Dalaigh has just said, perhaps a minor needs medical attention but she does not know where to go. Especially in emergency accommodation centres, there is no information at all. In direct provision accommodation there is information but in emergency accommodation there is nothing, unless one is told by somebody who has been there and has lived experience and says "You need to go from point A to point B."

Ms Clare Murphy

What we would wish for in Tusla is to have a culturally bespoke and appropriate placement for every child requiring a placement. We are, however, dealing with a situation where in 2022 we took in 176 children, for each of whom we had to find a placement. To date this year, we had to find placements and appropriate beds for 256 children. In the beginning, the priority for Tusla is, literally, to find a bed. After that, we try to meet all of the child's needs. This is happening on top of a system where we have a crisis in recruitment and retention of social workers, and we have a crisis in placements, including 96 Irish children waiting on an appropriate placement. So, while we would wish, we are playing catch-up. While we want to provide a far better service than we are providing, we have a capacity and resources issue and I need to put that on the record.

Senator Mary Seery Kearney

I thank the witnesses for that. It is easy to be horrified. In my mind and heart, I am still with the 15-year-old girl mentioned by Dr. O'Dalaigh, to be honest, and am thinking about that plight. We recognise, from everything the witnesses are sharing, that there is a huge amount of training and a huge amount of work. In anything I have seen in respect of the commitment from the Department of Children, Equality, Disability, Integration and Youth to Citywest, I have no doubt but that people are working hours way beyond what they are employed to work, and they are giving goodwill way beyond that. This comes out of a passion and commitment to children. I respect and honour that for a start. This is a precursor to the fact that I am going to give out a little bit.

In an ideal world we would have a place. Earlier this year I worked with the Amal project operating out of the mosque on the South Circular Road. The women there have done the most amazing work, especially around Ramadan, when they provide packages to families who are living in direct provision accommodation. Reference was made to the practical nuts and bolts of everyday living. The fast is from one hour before sunrise to one hour after sunset. It has been mentioned that in a lot of direct provision accommodation, there was no kitchen open so people had to have something in their bedroom to be able to cope with eating outside of those times. I was quite astonished that we had not anticipated this. To be fair, the Minister is open to looking at what we could do in that regard and agitate to do that. Within our provision, however, we did not anticipate the cultural aspect. We are dealing with a religion that is different to what we are used to providing for, and which has people who are particular adherents and who are committed. How do they cater for their children and for themselves in very limited accommodation? We did not anticipate that. As much as we do, we seem to miss some of the practical nuts and bolts.

This brings me to a place where I wonder that while we are allowing in more people and say we are going to broaden the work permit - I am 100% against the limitations - yet we have people in direct provision all across the country who are fantastically qualified and come with competence. Some of it is rooted in a stereotype that is well outdated in any way, shape or form. We have a demand in our workforce, yet here we have people living in the country. Let us go with that before we start opening up work permits, although I believe we need to do that as well. As we have people in the country doing that, let us open that.

However, for the 15-year-old, this is not going to be an answer. Even with opening up the opportunity to work, perhaps a 15-year-old cannot manage finances and clearly could be coerced out of those finances. What else needs to happen? I want to give the witnesses the opportunity to finish what they are saying. What can be done in a practical way, day to day, bearing in mind that everything Tusla is saying here is right and true? There is a recruitment issue and there are challenges but I do not believe there is a lack of heart. Maybe there is a nuts and bolts piece that sometimes we miss.

How can we do that differently?

Dr. Fiona O'Reilly

In short, of course, there are ways we can do things differently. We have to be pragmatic and recognise the new world, acknowledging that our policies come from a time when we were able to tell everybody's age. We looked at children and asked whether they needed to be protected by the State but we knew how old they were because everybody remembers when they were born. We now have a new landscape and we need to do things differently, from big policy to pragmatic differences. In big policy, we can open up how we welcome people into the country. They do not all have to come in through the asylum-seeking international protection system. If we made other avenues for people to come, make a better life and live and work here, we might reduce the number of people coming through the international protection system, for starters.

Of course, Tusla would like to put everyone who is determined to be a child into a perfect placement with culturally competent guidance, but we cannot do that. Putting people who may well be children, as a lot are, into adult accommodation is not the answer. There is an in-between. For people who are being assessed and might turn out to be children, where it may take months to carry out that assessment, we can put them into special accommodation with small numbers of people of a similar age. I refer to something between what IPAs are living with in emergency accommodation, which is not satisfactory at all, and the really good placements that people who are determined to be children are put into. Perhaps that is what the new system will do, but that is not what is there. Every step of the way, we need to think outside the box and not let the perfect be the enemy of the good.

Ms Kate Duggan

We engaged most recently with HIQA, the Children's Rights Alliance and NGO agencies, as well as our line Department from a policy perspective, to come together over the coming weeks and look at the tiered model of support. The onus is on us to provide an appropriate care placement, but almost 50% of males over 16 years of age who present to us do not want to go into what we consider a mainstream residential service under the care system. They want a different level of support where they can access education, training and employment and have a safe place to live.

We are working hard with colleagues and all the stakeholders I mentioned to identify the various tiered levels of support that are needed. On any one night, we could have up to 100 special emergency arrangements where unaccompanied minors are accommodated in Airbnb-style arrangements with an end key worker from Tusla. A lot of them are young people whose assessment is disputed or unfinished and where a determination for eligibility of services has not been made, so we do not place them in a residential unit or a foster care service with other young people but, equally, we do not refer them back to the IPO, where they would be placed in international protection. They are placed in those arrangements until we have a determination on eligibility. Nevertheless, it goes back to the numbers we are dealing with. There is a level of subjectivity and we are aware of that, so we are working hard to mitigate the risk of any child being placed in adult service provision.

Ms Sharon Mpofu

To add to what Senator Seery Kearney said, when it comes to the workforce, a lot of qualified people are international protection applicants in direct provision. A great deal of red tape around that is preventing people from sharing their experiences and what qualifications they hold. There are doctors, nurses and teachers in direct provision but there are limitations in regard to getting a work permit, and some people fear undergoing Garda vetting. It is a good thing to be Garda vetted if someone is going to be dealing with children.

When it comes to Tusla, people in direct provision are often terrified at the mention of it because most direct provision centres say they will call either Tusla or the applicant. I am speaking from my experience of direct provision, although I am not in direct provision anymore. A first-time mum who has just given birth through a C-section will have no help or support. If she has just been told she cannot leave the child alone in the room but needs to go outside to cook in a shared kitchen, how is that possible for someone who has just had a C-section? When she tries to go, she will be told Tusla will be called on her. When Tusla is mentioned to most people, it is almost as though the Garda will be called on them. They become afraid.

That is why some people end up doing things they are not supposed to do, because of the fear they are facing and the challenges the centres are presenting to those people. There might be a shared kitchen downstairs, but if you have a small baby and no one to help, with no visitors allowed in the accommodation, how are you supposed to survive? These people want to go out to work and study but they need to have been in the system for three years to be allowed to access education or to have been in the system for six months to be able to access a work permit. If people could get work permits earlier, some of the crisis in the workforce might be alleviated. It is always reported on the news that once people between the ages of 18 and 24 get a qualification, they emigrate. We have people in the country who are willing to work but cannot because of red tape. If that were looked at, it might alleviate the crisis we face.

Senator Mary Seery Kearney

Ms Mpofu is again pointing to an everyday nuts-and-bolts issue. I fully agree with her on the work permit issue. Fantastically qualified people living in our communities could be working and alleviating a lot of the challenges. As for the experience of a new mother, I have come across similar situations. The question of what to do, without being able to make decisions, use your discretion or look for a visitor to assist you, as well as the idea that Tusla can be weaponised against you, is dreadful. There needs to be some decisive cutting-through of that.

Ms Sharon Mpofu

The centre managers need proper training-----

Senator Mary Seery Kearney

They clearly have far too much power. It is not transparent.

Ms Sharon Mpofu

Yes, and they try to intimidate people. The new IPAS law states that if someone has got their status, they can be kicked out, so people are afraid to voice their concerns because they fear they will be chased out. If you have a two-week baby and you are chucked out, where are you going to go?

Ms Kate Duggan

As for the response, we very much welcome the fact that this year, through European accounts funding, 17 family support workers will be allocated, or one to each of the Tusla areas, to support directly parents and families within direct provision. Through the Children and Young People's Services Committee, CYPSC, which is about the health service, Tusla, county councils and the community and voluntary sector, a total of €1.3 million has been allocated. We are hopeful that in 2023, more supports will be given, as they have been, to support and show families in direct provision that support is out there and how to access services within the community. More is needed, but they are two good initiatives we have received from the Department that will benefit children and families in direct provision.

Dr. Alva O'Dalaigh

The age-disputed minors in particular are in a sort of no-man’s land where they do not have a guardian to sign for them, so they cannot sign up to school. Schools cannot accept them because there is no parent to sign for them. In some cases, they cannot access the medical care they need. We had a patient who is 16 years old and CAMHS was unable to see him. He was unwell psychiatrically. He had been seeing psychology, who felt it was beyond their scope of practice and he definitely needed to be seen by a psychiatrist. However, CAMHS would not see him because, in the first instance, they asked why he did not have a parent to sign the form. I told them he is an age-disputed minor and does not have a parent. I sent the documentation from Tusla which explained that he was ineligible under the Child Care Act. They then said they cannot see him and he has to be seen by the adult services. The adult services were not very happy about that but, ultimately, we had to email the Ombudsman and eventually the adult services saw him. They saw him once but he did not go to the second appointment because he is chaotic, a teenager and also unwell. They discharged him saying basically that if he requires further review, he should be referred to age-appropriate services. Essentially, he is in this no-man’s land where nobody is really happy to see him because of being in this funny place. If the age-disputed minors are not placed with families, at least there should be some sort of guardian who can sign for them to allow them to access the services that they need – educational and health.

Senator Mary Seery Kearney

As Ms Duggan shared, perhaps the new workers will be able to have a role and we can have some creativity about them having one. My only thing about that though, when it comes to what Ms Mpofu shared and other stories that I know of, is that workers go home. It is a bit like your child in the crèche. There is only so much you can complain about because you are afraid that your child is there on their own – but I have never had to complain about a crèche. There is a certain vulnerability. How do you complain and raise issues when you are living in the situation and you are quite powerless? We need some mechanism to overcome that. Again, with Dr. O’Dalaigh’s 16-year-old, we need some mechanism to overcome where people are disempowered and have a problem-solving intervention on a nuts-and-bolts level.

Dr. Aoibhinn Walsh

On disempowerment, our system is one of disempowerment for many people, especially within the international protection system. Ms Mpofu mentioned it with regard to a new mother with a small baby. I wish to paint a practical picture of something as simple, basic and fundamental as food. You do not even think about it when you think about challenges facing health, well-being or overall psychological well-being. When you cannot cook your children’s food or pick what they eat; when you have not cooked them the food they have eaten for the past seven years of their life; when you have five or six children and you are a single parent in one or two rooms and you might have two children with autism spectrum disorder and one with ADHD; when you cannot bring them down to an overcrowded kitchen because it does not suit; when your child is having a temper tantrum at the time you are supposed to be booked to use a kitchen in a facility; or when I am in front of you in clinic explaining that your child is underweight or overweight and you are telling me all you have in your room is a microwave and perhaps a toaster, it impacts every aspect of these children and not just their health. I am seeing the ones in extremis, whose health has been very clearly and objectively impacted but they have four siblings with them in the room who are also clearly pale looking and clearly underweight or overweight. This is something that we know. People have two- and three-year-olds who say “I do not like this” or “I want to do this” and want to feed themselves. If you do not have a highchair, or you have nowhere to feed your picky child, you have to spoon-feed them and that results in aversive behaviours. If they are not eating, they are failing to thrive. It is the practicalities that we take away.

I see many parents who feel that if you take away the ability of a parent or caregiver to feed their child, you are taking away one of the grounding aspects of their fundamental relationship with their child. We see the clear impacts that this has. It impacts on maternal or parental mental health when they cannot feed their child. I see a selected-out population who comes to me because they are in extremis. I refer to taking away a parent’s ability to provide basic needs for their child. You talk about something easy, or not easy, but this is something across the board that we could get right. The State is contracting to have people in hotels. I see children having chicken and chips for every meal with no access to fruit and vegetables. If we are paying these hotels to support and accommodate these families, let us ensure they are at least providing them with a relatively well-balanced diet.

Deputy John Brady

I welcome all our witnesses. I wish to home in specifically on primary education and some of the challenges there. I will pick up on a point that Ms Duggan made in her opening statement. Over the past 12 months, there has been a significant and unprecedented increase in numbers presenting to or being referred to the service. Ms Murphy mentioned a figure in terms of unaccompanied minors who are either presented or referred over to Tusla. I think it was 176 for-----

Ms Clare Murphy

Yes, it was 176 up to 2023 and since 2023 we have provided a placement for 256 additional children. I am trying to make the point that it is putting pressure on a system that was already under pressure. I was making the point that while we would love to find a culturally appropriate placement, we have limited resources.

Deputy John Brady

Absolutely. The point was well made when Ms Murphy spoke about the capacity and resource issues that were there prior to this huge increase in unaccompanied minors who have been presenting.

I wish to home in on primary schools. I spoke to a number of teachers over the past number of days to see what challenges they experience in dealing with traumatic experiences. Children are coming from all sorts of conflicts and war zones. The Ukrainian situation has presented huge challenges. I was speaking to one teacher who has a number of Ukrainian children in the classroom. When the fire alarm goes off, the children are under the tables, looking for refuge. That is absolutely appalling. They are dealing with children who have not spoken to their dad who is on the front line for three or four days, and trying to deal with all of that trauma.

Mr. Ó Ruairc presented a figure in terms of the psychological supports being offered for teachers. Webinars based on the Hobfoll principles were attended by almost 1,500 teachers, and we know the five essential principles contained in that. However, that seems to be a very low figure when there are more than 42,000 primary teachers in the State. I am not sure whether the witnesses would agree. Teachers are educators but there have been challenges presented here. I wish to tease out that figure to see what more can be done to support teachers. Again, I spoke to teachers and they said they found it hard to access and get supports that they need, and there are other situations. I am not sure whether anyone would have any information on the following. They are dealing with Ukrainian children, in particular, who are up at 5.30 a.m. or 6 a.m. and have to do online Ukrainian classes first at 6 a.m., after which they come into primary school to do a whole separate day’s work, essentially. There are then two lots of work on top of them at the end of the school day. I am not sure whether that is the norm and how prevalent that is. However, those pose challenges, additional burdens and stress on children in difficult situations.

I am conscious of my time. I want to touch on Student Universal Support Ireland, SUSI, grants but perhaps I will come back in on that if there is a second round.

An Cathaoirleach

The Deputy can come in now if he prefers. Everyone else has gone over time.

Deputy John Brady

I will ask about SUSI grants, particularly for individuals with stamp 4 status who are being denied these grants because, essentially, there is a ban on them. A number of people have been in touch with me on this matter. One instance concerned a 19-year-old woman who was accepted into the first year of an international business course in Dublin City University, DCU. As she was on stamp 3, she qualified for the grant. However, during the year, she changed to a stamp 4 and was then not only refused a grant and fees for 2023-24, but was also asked for more than €5,000 back that she had received from SUSI. I am working on that case, which is replicated in a number of different cases I am working on. There are challenges. I am not sure how prevalent this situation is or what is being done or whether it is being looked at. Certainly, it is impacting negatively on a number of people I am aware of. How prevalent is it?

Mr. Tomás Ó Ruairc

On the numbers attending the webinar versus the overall number of teachers and so forth, it is important to recognise that as regards the REALT structure I referred to, there is one for every ETB in the country. Each of those has a National Educational Psychological Service, NEPS, representative on it. There is close liaison between the REALT co-ordinators, the schools in each area and the NEPS representative in that area. NEPS also has one direct relationship with schools to help them pick up on things. In addition to the established relationship NEPS has with schools, where acute needs are identified, as the Deputy said, it is also acknowledging the impact of the war and trauma children have experienced in the early stages, which, of course, has become worse over time because the war has been going on much longer. To put it in context, the number is 1,500 across a number of schools. There could be a couple of teachers per school, but it is only one example of a suite of supports.

From the beginning, we have been very careful to be very cognisant of the impact of the trauma of war. For example, in the area of special educational needs, SEN, the advice to schools both from the SEN and psychology sides of the house was that trauma would have a significant impact on assessment need at the early stages. It was about adopting, as schools did, in fairness to them, a very humane approach of not rushing to do A, B, and C, but letting children settle in and so on, and providing a welcoming environment, which schools have done.

Webinars offered at the beginning were also offered in an asynchronous manner subsequently. There is live attendance but we can also make a webinar available to colleagues so it is up there to be accessed. There is also another series of webinars, Welcoming Children to our Schools; the training for school staff to build resilience for all; and the regional teacher support sessions where teachers can engage with NEPS and issues regarding newcomer children. There is also training for schools on embracing diversity, which will be available in the next academic year and a psychological first aid response course delivered during Covid has been translated into Ukrainian, Russian and, more recently, Arabic and Turkish.

The Deputy made a very important point on the online curriculum. We again work closely with schools, through the REALT structures in particular, to make sure they provide that kind of graduated integration of pupils into their schools. Number one, it is about a welcoming environment, and allowing children to settle and form peer relationships. The Deputy will appreciate that depending on the age of the young person involved, for those in the more senior years, from ages 16 to 18, who have recently arrived, and due to curricular differences from Ukraine, we tend to have more of a focus on finishing their Ukrainian education through the online schools referred to. However, based on some work done by the inspectorate, in the early stages in particular, we generally identified a greater emphasis on school engagement in primary education. That was understood at that point in time and it is continuing to evolve. There are easily approximately 1,000 young people in fifth year who will go into sixth year next year and, it is expected, will have their eyes on the leaving certificate.

We have been working very closely with stakeholders and school management bodies to make sure of matters from a wellbeing point of view. A very careful balance needs to be struck. One of the key principles is that connectedness to children's sense of self and sense of culture. We engaged with the Ukrainian ministry of education on the all-Ukrainian online school at the early stages of the outbreak of the war. That ministry was keen that children would have access to an online curriculum but was also conscious that those children were in another country and they wanted to integrate and so on. It was about trying to get that balanced message. Where we have identified some potential unintended negative impacts, and it was well-intentioned to have the engagement with both approaches, we will look at our guidance to schools. We issued guidance to schools twice on this. Initially, there was holding guidance in September last year, which was updated in December to take account of the evolving situation. It was looked at very closely again through the inspectorate to have new guidance ready for September. A year and a half has passed for many children. At the same time, there are children whose day zero will be today and tomorrow and they will want the same kind of response at the beginning. We are trying to adopt a rolling, layered approach, making sure, as the Deputy pointed out, that the wellbeing of children and young people is of principal importance.

It is a suite and network of connectedness at both local and national level, and taking account of the evolving situation.

An Cathaoirleach

What about the SUSI grant situation?

Mr. Tomás Ó Ruairc

That is for our colleagues in the Department of Further and Higher Education, Research, Innovation and Science. I am not in a position to comment on that. I apologise.

Deputy Jennifer Murnane O'Connor

I thank everyone for coming in. There are huge challenges within the system. I see it daily. I see people who cannot get GPs, occupational therapists, physiotherapy or dieticians. There are huge challenges. The one thing we have to do is make sure children are prioritised. Whether it comes to vaccinations or medical cards, we have to make sure that every child who enters our country is looked after. I see the challenges. I deal with them daily. A woman who has a medical card contacted me today; she cannot get a dentist. There are so many issues with recruiting and retaining staff, which was brought up. I live in CHO 5 where the Chair and I see huge challenges. I see them daily. An issue we need to look at is that of more GPs across the board. We need to get more GPs. This issue is on a national and government level but we need to sort out these issues to help sort out all the other issues we have.

My question for Tusla concerns what it outlined in its statement: "Tusla and the Children’s Rights Alliance are also jointly commissioning research into identifying integrated family support approaches for families living in the International Protection accommodation system, to inform how we can better support them." How much of this is done? There are so many challenges. Listening to the stories today, I am worried. Every child and person is so important. There is a huge lack of communication and information. Where I have serious issues, just from my point of view, concerns working with different agencies. We have Tusla, the Minister, the Minister for Health, the Minister for Justice and the HSE. Significant challenges come with that. That brings its own challenges as regards joined-up thinking and communication. What happens within the different Departments? Are they all on the one page? From here, how do they try to make it better? It is not right and we know that. We are sitting here because we know it is not right.

Staff are doing their best. I deal with the HSE daily, and I work with Tusla and the Department, as does everyone else. How do we sort the challenges out? We are all here for the good. How do we sit down and work together? On education, a school in the area where I live, which is delighted it has migrant children, has lost a teacher. I am approaching to the Departments, which are telling me money is there but there are recruitment and staff issues, it is trying to do this and that, and there is money for this. Yet, where I live in County Carlow, I have challenges every day and there is just no joined-up thinking.

My other area of huge concern is that of children with disabilities. How are we monitoring children with disabilities? What are we doing to make sure that no child with a disability who enters this country is being left unseen or has not accessed the GP care or vaccinations he or she needs? Those are the concerns I see. I work with all the different agencies and with different groups. As I said, while good work is being done, how do we work better? How do the representatives see us facing the challenges? What will happen with this? The Minister of State, Deputy Joe O'Brien, launched an action plan against racism in March, along with implementation of it.

The Department of Children, Equality, Disability, Integration and Youth has said it will continue this. I know it has been only three months but have there been changes? If so, where are the changes? If we are losing teachers while we are trying to promote action, and we are not doing things correctly through the various Departments, how will we find solutions for the challenges we have? As I have said, all of our children have to be looked after. It does not matter where they come from, every child is special and every child should be a priority and be looked after.

An Cathaoirleach

There are questions for Tusla and the Department of Education.

Ms Clare Murphy

Deputy Murnane O'Connor has mentioned several issues. She asked about the research. This has just been commissioned by Tusla and Trinity College and it is starting.

Deputy Jennifer Murnane O'Connor

Apologies for interrupting. Is there a timescale?

Ms Clare Murphy

I do not know the exact timeline. The Deputy also asked whether agencies come together and how it might happen. There is a recent example. We struggle to find placements for a certain cohort of children, including Irish children-----

Deputy Jennifer Murnane O'Connor

Of course.

Ms Clare Murphy

-----perhaps with disability, substance misuse or criminality. Recently the Ombudsman convened a group that brought together all of the Government agencies, NGOs and An Garda Síochána. Perhaps something like this would be a good platform to deal with separated children seeking international protection.

The Deputy also asked about children with disabilities. For us a child is a child. We liaise very closely with the HSE and we have joint working relationships and joint protocols with it. It is a struggle to provide for all of the children with disabilities for whom we need to provide. Our primary relationship is with the HSE and our joint protocol.

Mr. Tomás Ó Ruairc

I am not familiar with the details of the case of the school to which Deputy Murnane O'Connor referred. As she will appreciate, we are taking a whole-of-system view of school capacity because there are three broad pressures throughout the country, particularly at post-primary level. I am not sure to which sector the Deputy referred.

Deputy Jennifer Murnane O'Connor

Primary.

Mr. Tomás Ó Ruairc

There are Ukrainian and international protection enrolments and more than 15,500 Ukrainians and 2,800 international protection are enrolled in our schools. This is in addition to the almost 1 million children in the system. There are national demographic pressures with the population bulge moving through the system. There are also special educational needs. In each area we are looking to make sure there is sufficient capacity to cater for demand, particularly the numbers of international protection and Ukrainian children, which can change. We are taking a very careful whole-of-system approach to look at this and make sure we are managing classroom capacity and teacher capacity. We are taking integrated approach given the three significant pressures on schools.

With regard to joined-up thinking and how we collaborate, broadly speaking the REALT structure works very well for us throughout the system. This is based on feedback from schools, stakeholders, the inspectorate and NEPS. The very essence of structure is trying to address the core point of the Deputy's question, which is that there is local intelligence and local insights that, quite frankly, the centre does not have and that is best capable of responding to where places are available. We have tried to make the best of all worlds by making sure all of the REALT co-ordinators have access to the most up-to-data we have on school capacity at individual school level. REALT co-ordinators can access the system for their area. They can map out a radius of three minutes, six minutes and nine minutes in respect of a school's capacity, taking into account the reality of where children are living. They can try to make sure, as best they can, that solutions are in place for the children.

The teams have brought in State agencies such as Tusla's education support service, the National Council for Special Education and NEPS. They also have links with the inspectorate and school management bodies. Each of these structures have national and local representatives. It is about trying to make sure schools have the best of the policy at national level and the best of local intelligence and insight.

With regard to racism, overall responsibility for the plan lies with the Department of Children, Equality, Diversity, Inclusion and Youth. There are a number of key actions for us in the first year. These include progressing the development of the Traveller education strategy and establishing an implementation group to oversee the implementation of Cineáltas, which is the Minister's action plan on bullying. We will also commence a work and professional learning programme for school staff that builds culture and diversity awareness. This comes back to the question asked by Deputy Costello earlier about cultural competency and school capacity. We also progressing work with the National Council for Curriculum and Assessment, NCCA, on the curriculum with regard to teaching and learning about Traveller culture and history. We are also planning to review and update with the NCCA the intercultural guidelines for primary and post-primary schools. Deputy Murnane O'Connor may be aware that the plan was launched in March and we are working through each of these actions as I speak.

Dr. Aoibhinn Walsh

I will address the issue of children with disabilities because it is something I see and work with every day. I want to be careful about disability because I know children born in Ireland have been waiting a long time. This is about equitable access for all children. However, there is a very different need for access and escalation of care for a three-year-old child who may be in the process of receiving a diagnosis of autism spectrum disorder who has family with an income and has housing, be it rented or supported in the system. I will give the example of the case of an eight-year-old girl I came across recently. She has come to Ireland through the international protection service. She is severely impaired with what looks to me as autism spectrum disorder with an underlying moderate to severe intellectual disability. The forms to access the community disability network team, CDNT, are very long and the mother does not speak English. We completed these for her. They moved three times to various CHOs. The mother informed us through text when she moved and gave us permission to inform the new CDNT and pass on the referral. That is a large amount of work in itself. They were in accommodation where the child performed significant self-injurious behaviour, including banging her head against the wall late into the night. There were people thumping on the ceiling and the walls to quiet her down. The mother was afraid to leave the hotel room because she was afraid people would be verbally abusive and aggressive towards her child. She could not take her outside because she had no safety awareness. One of the hotels they stayed in was on a busy national route so the child could not be brought outside. Being outside was what used to regulate her. Her behaviour escalated.

We have put together a national pathway through the HSE, signed off by the national clinical lead, to try to identify those children who need priority and would come under progressing disability services priority one access because of severe neurological impairment or significant needs. Families in hotels who do not have knowledgeable support workers in place very much rely on word-of-mouth awareness to understand how they can access disability services. There are also children who are not in appropriate schooling because their needs are not recognised.

To access other services people often need a diagnosis. This can take a long time. People are referred for an assessment. There are many members in a multidisciplinary team. To speak frankly, someone does not need to be a medical professional to identify there is the clear and significant medical or developmental need for some children. Each child having to go through the same process is transparent but there are some children who should very much be a priority with regard to being identified and at least linked with services that can prevent a crisis in care. This might involve getting a wheelchair or having an appropriate seat. I know of a case of a three-year-old child who could not support her own head to feed. She was choking and aspirating because she did not have an appropriate chair. Highlighting needs such as these should very clearly be within the remit of the CDNTs.

We frequently email the various heads and administrators trying to advocate. I have an excellent contact who has been mandated with the care of Ukrainian beneficiaries of temporary protection. I do not have a similar contact person for international protection applicants so that I can flag cases as high need. There is disparity in the care given, which means international protection children are not afforded the same level of care or recognition as Ukrainian refugees or other children born in the State. That impacts on their education and wellbeing. We cannot underestimate the effect on the mental health of care givers of living with these children with no resources, respite or even social support.

Dr. Fiona O'Reilly

Communication and information has been suggested as a solution and we have been asked whether we should be doing more in terms of sharing information and good communication. There are good examples of innovative approaches that are working. The Lynn Clinic established by Dr. Walsh is one of these. People can quickly get access to specialist care for children who have just arrived in the country and have all of the difficulties we have spoken about.

That kind of approach is needed and can be done in general. I know the HSE National Social Inclusion Office is trying to establish a health assessment questionnaire for international protection applicants, to be available wherever they go around the country. As it stands we see and have seen thousands, and we still have their records. We give them notification to email us for their records. However, none of their GPs know where they are gone. We are not told. Yet, they are in the system somewhere and somebody has given them a medical card. We have their records now, which is complete duplication. Public health nurses are a good resource. We do not have enough, but there are public health nurses in all of the areas. In north County Dublin, they happen across some of the emergency accommodation and find a pregnant woman, or someone who has just delivered a baby. The nurses have not been told. It sounds like maybe the schools are told what is happening with the Ukrainians, but much less about the international protection applicants. As I said in my statement there are also more significant structural barriers for access to care for the international protection applicants.

Ms Sharon Mpofu

I will speak to the challenges being faced by children in international protection, whether in primary or post-primary education. In most cases, children get transferred from Dublin to Cork in the middle of a school term. The kids are in class, and they have made friends, but in the middle of the year they get transferred to County Cork, County Mayo or wherever. On its own, that disturbs the children's education and what they would have learned. They might find that was being learned in Dublin has already been done in Cork, or it might be something they have still not done. The child will wonder what he or she is doing. Some children also get transferred into a remote area, where there is no public transport at all and the school bus is already full. There is no space for the kids, and no other means of transport to get them to school. It becomes a challenge for the parents too. I thank the Government for seeing to it that children in primary school get textbooks next year.

An Cathaoirleach

The free books.

Ms Sharon Mpofu

Yes. However, some people with kids in post-primary do not qualify for the back to school clothing and footwear allowance, so they do not have enough money to buy books. The parents rely on the €38.80 they get per week. There are things in school that need to be paid for. That becomes a challenge for parents, and also for children with disabilities. Quite a lot of parents, mostly coming from African countries, do not know their kids have any sort of disability. We are not vested in that, or made aware that there are certain types of disability. For example, if you tell a person in Africa that a child has autism, they will ask you what it is. They just know that the child is hyper, but they do not understand the extent to which the child has a disability. When people come here, and are maybe told at a GP appointment that their child has a disability, it comes as a shock. It is also a challenge to get an appointment to have the child assessed for that disability, so the parents can get more knowledge of how to handle or deal with that. I know there is already a backlog when it comes to getting an appointment for any specialties. The Department of Health and the HSE could try to fast-track appointments to see what type of disability a child has, so at least the child knows. I know there is a waiting period when it comes to treatment and how to integrate. However, at least the child is aware of what he or she has to deal with. I think it will help if that can be addressed from the grassroots up. It will also give the parents knowledge and understanding of what they are dealing with.

Senator Lynn Ruane

I will return to our earlier conversation, for my own clarity. When we sit down to make recommendations I want to be sure that what I am thinking of is relevant in terms of the report that will be written. I will ask some clarifying questions. This question was potentially asked at a different committee, but I cannot remember the answer. If a potentially disputed unaccompanied minor, later determined to be a minor, is taken into the care of the State, is he or she entitled to aftercare like other children?

Ms Lorna Kavanagh

Yes, if they have spent 12 months in the care of the State.

Senator Lynn Ruane

They need to have spent 12 months in the care of the State. Let us look at a scenario where an disputed unaccompanied minor, a girl for example, has spent ten months and time is ticking down where she is not in the care of the State. It is then recognised that she is a minor.

Ms Lorna Kavanagh

It is backdated.

Senator Lynn Ruane

It will be backdated.

Ms Lorna Kavanagh

Yes. It is backdated to the date of the initial referral, not even to the date of the initial assessment.

Senator Lynn Ruane

These are the little things I need to make sure of. What else is backdated? Let us look at access to education, and at the ability of somebody who should have been in fourth year, fifth year or sixth year. Time is ticking on for him or her. In reality he or she is going back to school as an adult. If he or she cannot go to school as a 16-year-old or 17-year-old and then turns 18, we are saying he or she cannot get his or her schooling years back.

Ms Lorna Kavanagh

The vast majority of our young people would not be in the school year aligned to their age. The vast majority of young people who arrive would need to spend one year in transition year to improve their English language ability. They will then start in fifth year and sixth year. A lot of our young people do not actually do their leaving certificate until they are 19 or 20.

Senator Lynn Ruane

In that scenario we are saying that adult age is appropriate in a school setting.

Ms Lorna Kavanagh

I know there are 19-year-old Irish children doing their leaving certificate.

Senator Lynn Ruane

That is just a discrepancy, as I am pointing out. I want to go back to the medical assessment. The medical assessment margin of error is only two years. It is very small. If we are saying that a 17-year-old could potentially be a 19-year-old according to the medical assessment, we are already allowing 19-year-olds in youth settings, even in youth work. The youth work provisions also go up to the age of 23.

Ms Lorna Kavanagh

Yes.

Senator Lynn Ruane

In reality, that margin of error is quite small, unless you are in a shared room and you might need some safeguards in place. Where the margin of error does not matter is in the cases that have been put forward of the 15-year-old or 16-year-old. The margin of error is two years, so he or she is still under age. It only really comes into play as a questionable metric if we are looking at 17-year-olds.

Ms Lorna Kavanagh

I will give an example of a case. We do not hang our procedures on individual cases. We often have young people who present and state their age as 15. Later, at the point where they are making their international protection application, they will tell us they are not 15. They might be 17. However, they have been told by the agent or smuggler who brought them in to say they are 15. We have to try to build trust with young people to ensure that even though they are still a minor, if they are not 15 but 17, they need to be clear about that for their international protection application. I understand that the young lady in this case is saying she is 15. We would have to assess her as a minor. We do not do medicals, so the two-year age gap does not come into play.

Senator Lynn Ruane

Should we have medicals for those cases? Regardless of whether she is 17, she is still a minor.

Ms Lorna Kavanagh

Yes, that is something we are looking at. It will not be an invasive medical. It might be dental or something. The other side is that we sometimes have young people presenting who are 25, and are claiming to be a minor and then it evolves.

Senator Lynn Ruane

The two years of error would differentiate that. They are either 23 or 27.

Ms Lorna Kavanagh

A medical in that instance would be indicated. However, we are not there and there is no provision in our legislation for that. That is, again, this provision in the International Protection Act-----

Senator Lynn Ruane

The legislative provision that is required-----

Ms Lorna Kavanagh

It is in the International Protection Act for them to conduct medicals.

Senator Lynn Ruane

I understand why the witnesses say they are not doing it, but I am trying to get to the crux of the cases and to determine where we probably should be using them.

Reference has been made to the backdated piece. The backdating of care has been discussed, but other services that may have gone awry during that time include education, the National Educational Psychological Service, NEPS, psychological supports, autism supports, speech and language therapy and occupational therapy. Is it just the aftercare? This may not be a question for the witnesses as it relates to the HSE and the Department of Health as well, but if the State wrongly categorises somebody for a period of time or it has a detrimental impact, should there not be an automatic right not only to the provision of aftercare but also to the healthcare the person should have received as a young person, even if the person has turned 18 in the interim while the appeal process was ongoing? It is nearly a case of providing redress.

Ms Clare Murphy

We would think so but it would be for the HSE.

Ms Kate Duggan

We advocate on behalf of a young person to have that happen.

Ms Lorna Kavanagh

In general, the vast majority of our people do not present with disabilities or a high level of medical needs. There are issues around nutrition and all of that, but not in terms of the need for high-level supports and diagnoses. By virtue of the fact that they have got here, as they are often selected within the family as the most resilient member and the person who might make the journey, that is not something that arises. However, we have had young people who presented and very early on it became apparent that they had a learning disability. For example, we would be very proactive around engaging with our HSE colleagues. We make such young persons a ward of court and they transition at 18 to appropriate disability services. It is about the appropriate response at the appropriate level from the HSE. We generally have very good supports in terms of getting those services for young people. We have links to therapy services that we have developed with therapists working in Trinity College. There are psychologists who do direct work with our profile of young people. We link with the Spirasi centre when young people are demonstrating trauma associated with torture. We try to align the children with the specialist services wherever we can.

Senator Lynn Ruane

In the interim, while the services are trying to figure out all the stuff around the age assessment, is Safetynet suggesting that there be a third option for those whose age is disputed? Obviously it is not adult accommodation and it is not accommodation with relatively young minors, but some sort of in-between process where they are still treated as minors but with a question mark. They are not adults with a question mark. We seem to go in the other direction. Instead of treating them as minors who could potentially be slightly over the age of 18 or in their early 20s, we should be treating them as children with a question mark because the detrimental effect of treating them as adults with a question mark is problematic.

Dr. Fiona O'Reilly

Definitely. I thank Senator Ruane for teasing that out. I was not aware of the backdating. The Senator may have seen in one of the case studies that one person had his claimed age accepted the day before he turned 18. He had his original assessment when he arrived a year and a half previously, when he was 16, and then he got his age accepted. I am sure he has no idea that he is-----

Senator Lynn Ruane

Entitled to aftercare.

Dr. Fiona O'Reilly

-----entitled to education. Schooling is a big thing. The healthcare impact comes out of the accommodation, the stress and the trauma. These children are not unhealthy. Of course, there could be some disability but, in the main, what they are looking for is education. That is really useful. Senator Ruane is correct that we say those who claim to be children should be treated as children and accommodated as such until the process has concluded. That includes the appeal. If that is the case, we could then provide all the information so they know where they are in the process and what may be due to them if, at the end of the process, they are determined to be children.

Ms Kate Duggan

That is the benefit of having advocacy built into our process, and the right of review. We are the first to say we did not have that previously. We have worked really hard with all of our partner stakeholders in recent months to strengthen the criteria. It is still not gold standard in terms of our ability to deliver, but it is certainly strengthened. We think the benefit of that will be seen.

Dr. Aoibhinn Walsh

I will make a very quick point about the communication piece. We look at fixes that can be applied on a population level given that each individual child has so many needs. There is an absence of electronic healthcare records. We look at children being seen by multiple different health and social care professionals, whether it is disability services, primary care, dieticians or speech and language therapists. Even the name can be an issue. I could get a name sent to me based on the way the person who referred the child thought the child name was spelt through a translation app. We see the child and then he or she comes through to another service with a corrected spelling and is registered as two separate patients. As a result, the records are kept completely separately.

If we tee up a complex of specialised appointments for a child, who might be otherwise completely healthy but, for example, has a heart defect that needs a review, that is a complex tertiary level service. If a hospital does not know the child has moved on, he or she can miss an appointment. It would be helpful if there was some way within the constraints of the general data protection regulation, GDPR, to be able to know when these children move and where they move to, so that there is no lapse or failure of continuity of care. It would enable a much better use of all the resources being put in place to manage and support these children if we were able to locate them and if a hospital were able to liaise on a child with very complex needs, who could get very unwell and need ICU care. The local hospital in Castlebar should know about the child and have a medical record for him or her, rather than being there at 3 a.m. using Google Translate with a child who could potentially need an urgent transfer to an ICU in Dublin because no one knows his or her medical background. That is something that should be done, although I do not know how it would be done in the absence of electronic healthcare records. Some system is required so that these children can be located and their relocation known to the health and social care professionals involved with them. That would be of clear benefit to their well-being. We spend a huge amount of time doing that.

Senator Lynn Ruane

Could that come with an amnesty? I am aware that people may be frightened of being followed around the country, in the sense of there being a fear of being sent back. Perhaps they are waiting on an appeal; there could be a lot of fear around that. Something like that would require an amnesty of some sort so that it is only the healthcare professionals who would have access to that information and there would be no reporting to IPAS or some other body.

Dr. Aoibhinn Walsh

What we do when we meet these families is very clearly get their consent to link with people. We explain that the child is going to need these services going forward and ask if they are happy for us to contact IPAS when the next appointment is coming through if the person has not been in touch or we cannot get through to his or her to find out where he or she is. By and large, Senator Ruane is right. All caregivers tell us that there is such fear there that is has to be very clearly explained.

Senator Lynn Ruane

Could the caregiver say, "No, do not contact IPAS."

Dr. Aoibhinn Walsh

Yes, but we have other safeguards. We give them our contact details and email address and we reach out to them ourselves. There are times when it can be very difficult, however.

Dr. Fiona O'Reilly

There is something, but it is probably not as detailed as Dr. Walsh outlined. The HSE is working with the national social inclusion office. During Covid, everybody's certificate and PCR were centrally available. Work is being done on a similar system for international protection applicants who are screened. It would include children and some of what Safetynet does for the national social inclusion office. When we do a health assessment, we can find out if there are any chronic illness or acute disabilities and store that information on a central portal so that if and when people are moved, it is available for planning and identifying people to have their care needs met.

As the Senator said, however, we are looking at the moment at general data protection regulation, GDPR, so it would have to be an opt-in. It has to be, and it would be for their healthcare needs.

Senator Lynn Ruane

And with relevant information.

Dr. Louise Campbell

It would be, yes.

An Cathaoirleach

Okay. I thank everybody. That was a really good and informative session. I thank everyone very much for being here and giving their time and answering all our questions. I thank our members as well. I need to get agreement to publish the opening statements on the Oireachtas website. Is that agreed? Agreed. We will adjourn and the committee will meet in private session on Tuesday, 4 July.

The joint committee adjourned at 5.20 p.m. sine die.