The way health professionals assess possible cases of abuse is likely to be transformed by ground-breaking research into child neglect, the most prevalent form of child abuse in the Republic.
The top recommendation of a study to be published tomorrow is to bring the voice of the child to the forefront of any assessment. Childcare workers will be encouraged to especially listen to children's views before deciding whether they are neglected. All childcare staff, from the top down, have welcomed the findings and recommendations.
The North Eastern Health Board and its childcare department decided in 1999 that it had to address concerns about the continuing high numbers of child-abuse cases it was dealing with. At the time, 53 per cent of all child-abuse cases referred to the board were of suspected neglect.
"We wanted to look more closely at those cases, because they represented such a large group of referrals. We wanted to examine how we dealt with these cases, how decisions were taken and if we needed to make changes in the way we were working with these families," says Nuala Doherty, the board's director of childcare services.
At the same time, Children First, the national child-protection guidelines published by the Department of Health and Children, recommended a standardised approach to childcare management. "The guidelines are broad, and we felt there was a need for a more detailed form of assessment. Neglect, both nationally and internationally, constitutes the largest percentage of cases; we were also concerned at the serious long-term effect on children of exposure to neglect.
"It has a significant impact on their development - their intellectual development, their ability to form relationships in their lives - and there is an intergenerational component to it," says Doherty.
Child neglect is one of the most complex care issues, yet there has been very little research into it in western Europe. There are more child deaths in the Republic due to neglect than to any other form of child abuse.
The board asked Jan Horwath, a senior lecturer in social work at the University of Sheffield, to carry out the research because of her experience in the field in the UK.
The four main findings were that, despite recognising the importance of working with children in partnership, the children have been marginalised; there is a lack of common understanding among staff about the meaning of child neglect; childcare staff had a range of perspectives on the purpose of the child-protection system, which in turn influenced the way cases were dealt with; professionals such as teachers or doctors seemed confused about their roles.
The study recommended that childcare workers could deal with neglect cases better by changes in approach, training and supervision.
One of the keys areas Horwath examined was the definition of neglect; the Children First definition refers to acts of omission by parents, those things that are not done in a physical, emotional or psychological way that impair children's welfare. Children could be deemed neglected if their parents are not meeting their basic needs for food, clothes, warmth and hygiene.
Neglect rarely occurs without reason. The children who come to the attention of health boards are often those from economically deprived backgrounds, and there is a high association of poverty with child neglect.
It often occurs where there are other problems, such as alcohol abuse, domestic violence or a mental-health problem. Neglect has a lower profile than sexual or physical abuse, however, and it has not been well researched in the past.
Horwath began by reviewing files of existing cases and new referrals relating to 130 children. She met staff involved with each case, reviewing the way they were assessed and dealt with.
She also sent a questionnaire to 75 staff working across the social-work department.
"It partly looked at the profile of the workforce, the assessment criteria staff would use and their personal and professional perceptions that influenced that process," says Nuala Crosse, a social worker and member of the steering committee set up when the research began.
In the final stage, Horwath met focus groups and spent time with managers, social workers, team leaders and staff. The ideas that emerged were then further discussed.
"We wanted to engage and involve staff in the process of guiding the research and ensuring that it was appropriate . . . and we were left with a sense of ownership. We felt that would help with the implementation of the recommendations," says Doherty.
Engaging staff allowed them to examine their perceptions and understanding of neglect and analyse their responses to it.
"We regard the board's staff as its greatest asset, so addressing their needs in terms of their capacity to do their work is in fact enhancing the response of the board to the parents and children," says Doherty.
The steering committee is quick to acknowledge the shortcomings identified in the research and welcomes the recommendations on addressing them.
One of the principal recommendations is that the health board introduce to its investigative process a framework for assessment, to look at children's needs and how their parents meet them.
"Our work tended to be incident-focused rather than the longer view.
"We also found we were looking at the parents or the children, and we need to do both; we needed a holistic approach and that is now in the framework document.
"We are looking at the strengths and needs of the child and family, because we don't want to be in their lives forever," says Kerry Mullen, a senior social worker in Cavan/Monaghan.
The report on the findings has sparked much interest among other health boards and voluntary groups working with children. It has the potential to change the way child neglect is assessed, as well as the authorities' response to it, and is the first report of its kind in the Republic, if not Europe.
With the steering committee overseeing the implementation of the findings, the next step is to pilot the framework by applying it to two existing cases and four new referrals; the results of that are expected next summer.
Horwath will shortly begin a new project for the board, researching the role of other adults, particularly professionals such as teachers, in spotting and reacting to possible cases of neglect.
Christmas is often a time when family problems become acute, and it is frequently the children who suffer.
This research could help those charged with caring for the most vulnerable in our society to do the best job they can throughout the year.