A range of remedial interventions involving all sectors of society is required to address the diverse needs of vulnerable children, writes HELEN BUCKLEY
THE PUBLICATION of the Independent Child Death Review Group report provides much needed empirical information on the impact of social adversities on vulnerable children and families, as well as the challenges faced by Irish child protection services.
Although a number of valuable individual inquiries were previously published, a report like this, where a number of cases are reviewed together, provides the opportunity to profile significant themes. The rudimentary child protection data published by the Health Service Executive each year classifies child maltreatment in what may be described as a clinical fashion, using the categories of physical and sexual abuse, emotional abuse and neglect, but the case examples in this report bring those somewhat sterile terms into reality.
They illustrate what it is like to be a child exposed to trauma, who knows little or no stability and whose capacities to grow, be healthy, learn, make friends and manage themselves are severely compromised. They also demonstrate the gap that can exist between the needs of a child and the response provided by the required services.
The report elucidates what more abstract data fail to show – the interconnectedness of factors such as alcohol and drug misuse, domestic violence and parental mental illness in families, and the subsequent emotional abuse and neglect of children. It similarly shows how the accumulation of more than one negative familial factor accelerates the rate at which children are affected in their early and middle years.
The review group’s analysis of the age profiles and the contexts in which the children died reveals the complex needs of this population. It mirrors the trends demonstrated in the reports recently published by the National Review Panel on child deaths since 2010, and replicates international research evidence indicating that risk escalates when vulnerable children reach their early teens. In a number of the cases in this review, the young people had been known to the services from quite an early age, but had tended to be somewhat “invisible”, as neglected children often are, failing to elicit attention to their own specific needs and “getting by” just beneath the radar of professional intervention.
By the time they reached their teens, many were displaying the typical consequences of chronic parental neglect and exposure to trauma.
Their everyday coping skills were limited and, typically, their attendance and performance at school were erratic; in fact, a number of them were unable to read or write and early school dropout was common.
These disadvantages greatly lessened their motivation and opportunities and rendered them more susceptible than the average adolescent to diminished self-regulation, anti-social behaviour, addiction and mental health problems. In a number of cases, this negative trajectory caused a downward spiral of risk-taking behaviour, to a point where it became difficult for professionals to intervene either within or outside the care system. The high rate of drug- and suicide-related deaths of those in the after-care system is a sad illustration of this point.
While the report provides evidence of good practice in some of the cases reviewed, it gives numerous examples where the HSE child protection services fell short of the mark. These included instances where assessments were incomplete and social work involvement ceased despite the presence of ongoing risk factors. This type of practice indicates a lack of understanding by practitioners of the destructive effect of neglect and psychological harm, but also reflects a national pattern whereby the pressure on social work teams frequently exceeds their capacity to respond, resulting in the application of increasingly higher thresholds for intervention.
The decreasing rate at which reports made to the HSE are substantiated is an illustration of this trend.
Ten years ago, 35 per cent of reports made to the HSE were “confirmed” as child abuse, but according to recent HSE data, that figure had fallen to 5 per cent by 2010, a statistic that may not be totally accurate but nonetheless suggests that the system has been under increasing stress.
The standard of record-keeping in HSE children and family services has been repeatedly criticised in previous reviews, and this report graphically illustrates how the lack of child-centred information led to fragmented service delivery and inability to plan appropriately in order to meet a child’s needs. It also impeded continuity of the flow of information when, as inevitably occurs, staff move on.
The under-use of technology to facilitate data-sharing within and between the various children’s services is remarkable in a sector that deals with such multifaceted and complicated cases, and would unlikely be tolerated elsewhere.
A review commissioned by the HSE and published in 2010 had already observed that the Children and Family Services lacked direction, required leadership and operated inconsistently. This report has provided further evidence of the need for radical reform and urges the statutory services to implement and adhere to benchmarks of good practice that are appropriate and measurable. However, it has also revealed a broader requirement for the sharing of child protection responsibilities across services.
The report has reiterated a truism that is replicated in most child protection systems: that the problems experienced by vulnerable children in both the care system and the community are so diverse as to require a range of remedial interventions. Importantly, it shows that interventions must be made on time and in a manner that encourages rather than discourages engagement. The mental and physical health needs of this cohort of children were striking, yet the overall picture presented by the report was of a tardy and unco-ordinated response in many instances, characterised by delays and waiting lists, with little appreciation of the damage being caused.
The unique overview provided by this report highlights the various points at which intervention is required in the lives of vulnerable children, and illustrates many lost opportunities in the cases reviewed. While it shows deficits in the practices of individual professionals, it makes the point that many of the weaknesses exposed are systemic, cascading down from policymakers to the front line.
In its acknowledgment that the work is challenging, the review sends a strong message that a more effective response to vulnerable children requires a holistic and committed approach, not just from statutory services, but from all sectors of society.
Helen Buckley is an associate professor in the school of social work and social policy at TCD, and is the independent chairwoman of the national panel that reviews serious incidents including the deaths of children in care.