Prevention is not only better than cure, but also cheaper, particularly where a cure may become progressively more difficult or even impossible. Two separate reports this week echo the importance of prevention.
The first, the Second Interim Report on the Child Care Law Reporting project, gives an insight into the kind of life circumstances that precipitate a visit to the District Court for a care order for a child. The vast majority of the families that end up in the District Courts are parenting alone. People from ethnic minorities are disproportionately represented. One in six of the children has a parent with a cognitive deficit or mental illness, while nearly one in three of the children has special needs.
While lead author Dr Carol Coulter has made a compelling case for reform, including setting up a dedicated Family Court, I think she would be the first to say that it would be far better if preventative measures ensured that many of these cases never came to court at all. Unicef also highlighted this week that there are 130,000 more poor children in Ireland than there were before the recession. This is not solely because of an economic meltdown, but as a result of policy choices. Other countries reduced their child poverty rates during the same period. These policy choices will increase the numbers of families experiencing dysfunction, as poverty is a key issue, though not the only one. Many people would agree with what Declan Dunne, chief executive of Sophia, a voluntary housing agency, said in this week’s Health Supplement, that he “believes the missing piece in so many troubled lives is the solid foundation of a secure and caring family”.
Chaos to crisis
Both Dr Coulter and Declan Dunne have pointed out that costly State services in the areas of justice, addiction, homelessness, school attendance and mental health are being focused on different facets of the same 10 to 15 per cent of the population, the ones who lurch from chaos to crisis.
The low-cost community mothers scheme delivered in the Greater Dublin HSE area is prevention at its best. It grew from a 1980s initiative in Bristol where public health nurses delivered a targeted, structured programme in mothers’ homes during a baby’s first year. That first year never comes again, but if well-managed, can change the trajectory of a child’s life.
In Ireland, a pilot project also used public health nurses, but when money ran out, the bold and innovative step of recruiting and training local women volunteers to deliver the programme instead was taken. They deliver vital support services to families at virtually no cost to the State because they only receive expenses. This initiative is non-stigmatising, because it is delivered by women from the community. The reasons for being visited might range from being a Polish mother who is desperately lonely and doesn’t have much English to being a young teenage mother. Dr Coulter’s report points out the urgent need to integrate ethnic minorities. The community mother model is particularly helpful for people who have reason to be fearful of authority figures they see as representing the State.
For example, community mothers visit asylum seekers in Hatch Hall in Dublin. (I have been in Hatch Hall, and it is shocking to see entire families sharing a room originally designed to house one university student.) They also visit Travellers.
The scheme was facilitated by the HSE in the Greater Dublin area, and overseen by public health nurses. In 2013, there were 119 unpaid community mothers, who visited 1,361 families. There are breastfeeding support groups, and mother and baby clubs serving more than 500 families, also run by community mothers. In 2012, the programme was selected for inclusion in the European Platform for Investing in Children (Epic) website, in the evidence-based “family practices” section. Visitors from Singapore came here this year to see how it is done. However, this scheme seems to be under threat, perhaps because of economic policy decisions that prioritised short-term savings.
Of the 12 programme areas in Dublin, Wicklow and Kildare, there are eight unfilled vacancies for public health nurses who supervise the scheme, apparently due to the moratorium on recruitment. So two-thirds of the areas have no co-ordinating public health nurse, and despite repeated queries over two days it was not possible to establish from the HSE whether it is planning to recruit any. The scheme will not survive if it does not.
Ironic
The second factor is profoundly ironic. When the new child and family agency, Tusla, was set up to ensure greater co-ordination and communication between child protection, early intervention and family support services, the director of the community mothers scheme was transferred to Tusla, but that person was the only staff member who was. The public health nurses who work with the director remain within the HSE. So the scheme is now falling between two stools, as a result of setting up an agency meant to prevent exactly that. The mothers scheme is an Irish innovation that works, and helps to prevent cases escalating. It will be a tragedy if it is allowed to disappear.