Dáil Éireann Debate, Thursday - 4 July 2013
45. Deputy Denis Naughten asked the Minister for Children and Youth Affairs her views on the audit report which was produced on foot of a specific recommendation of a public inquiry into the Roscommon child care case; and if she will make a statement on the matter. [32346/13]
View answerI welcome the publication, by the HSE, of the 'A Review of Practice and Audit of the Management of Cases of Neglect'. The report was received by the Department of Children and Youth Affairs in May 2013 and it was published on the HSE website two weeks ago.
This report follows the publication, in October 2010, of the report of the Roscommon Child Care Inquiry, which catalogued a number of concerns arising from the examination of the management of systematic and problematic neglect in a family known to the HSE Child Protection Services. The findings of the Inquiry raised concern that this might not have been an isolated case and that there might be more widespread practice and governance issues in the management of cases of neglect, both in Roscommon and throughout the country.
This lead to work on a National Audit of neglect cases. From the outset, it was the intention of the HSE that the neglect audit would comprise a number of phases. Therefore the audit was not simply a once off exercise but constitutes one element of a wider process to improve practice in relation to such cases across the country.
For phase 1, the HSE commissioned the services of Ms Lynne Peyton, an Independent Consultant in Child Protection, to complete an initial pilot audit of the Roscommon cases. This pilot was extended to two other local health areas, Waterford and Dublin South East. This pilot phase [Phase 1] was conducted in early 2012 and this was worked on subsequent to completion. The composite report, published two weeks, therefore represents the findings of the pilot phase; and is designed to inform a more significant National Audit of Neglect Cases.
Since its completion this document has acted as an important working document informing preparations for Phases 2 and 3 of the process, namely, the workshops for staff and the National Audit of neglect files. Last August, the attention of HSE social work staff was drawn to the on-going and systemic impact of neglect as identified in the three audits.
However the report in itself does provide some key learning with respect to service improvements and in this regard the HSE has developed an implementation plan to address the recommendations of the report. This has now happened, and the HSE have already demonstrated progress in relation to very many of those actions.
In Roscommon: there have developments with respect to implementation of monthly child care meeting chaired by the General Manager; restructuring of Social Work Teams and the streamlining of Family Support Services to include a single point of entry for referrals. In addition, more than fifty staff in all relevant disciplines have participated in training on the Identification of Neglect.
In Dublin South East the Social Work Department has been restructured and the new arrangements are working more effectively. There has been a blitz on the waiting list and unallocated cases have been significantly reduced and are constantly reviewed. New standard business processes including in relation initial assessments have been implemented and mew collaborative arrangements and joint training has been progressed between social work and a range of other disciplines including: child and adolescent mental health, speech & language therapy, psychology, etc.
In Waterford, the pilot phase of audit has led to a substantive structural alteration of the deployment and governance of child protection services in Waterford. In addition new internal quality assurance arrangements have been introduced, including an increase in the frequency of staff supervision.
With respect to the general findings, I believe this audit contributes to greater awareness of neglect, highlighting the "harsh reality of neglect".
The Audit found that parental alcohol misuse was a factor in 62% of families in the overall sample; and states that "family dysfunction was often associated to chronic alcohol and drug misuse".
The Audit further found that
- domestic violence was a reported feature in almost two thirds of the sample cases;
- parental mental health issues also featured in approximately 2 thirds of the Dublin;
- standards of hygiene and physical conditions were unacceptable in more than half of the cases; and
- non-attendance at medical and other specialist appointments with speech and language therapists, psychology and CAMHs was a feature.
The audit highlights how referrals of neglect cases in Roscommon & Waterford have tripled in the period 2005-2009. On a positive note, the audit found that "emphasis on providing Children First training ... was paying off in terms of appropriate referrals".
However the Audit did find that there was too much variation and inconsistency across local areas. I believe that establishment of the dedicated new Child & Family Agency represents an essential response to this. At heart of new Agency will be a new Quality Framework, led by a newly-appointed Head of Quality.
In relation to the specific issue of responses to referrals relating to neglect, a very significant body of work has been underway, in tandem with establishment of the Child & Family Agency to develop new standardised models for referral and assessment.
Instead of prioritising abuse cases to the detriment of neglect cases, the new models, which have been subject to a number of pilot projects throughout the country, seek to differentiate of child protection and child welfare cases with a view to ensuring timely and proportionate responses to each.
A new model for family-based, multi-agency assessment and early intervention known as 'Meitheal' has already been trialled in two regions (Sligo/Leitrim and Donegal and in Limerick) and is being mainstreamed as part of the establishment of the new Child and Family Agency.
In addition, under the agency’s new Service Delivery Framework, work is at an advanced stage on the development of what are to be known as Local Area Pathways, which are with be local networks of statutory and NGO providers, which will be in position to respond immediately to child welfare referrals, including cases of neglect; by providing a range of services to multi-disciplinary services, including family support.
In conclusion, I look forward to the conduct of the national audit and the ongoing work on establishment of the new Agency and accompanying reforms.
