In a provincial district court, the Child and Family Agency (CFA) applied for a full care order until the age of 18 in respect of a child with gender dysphoria. The child was of African background and had been adopted. At the outset of the hearing, it was clarified that the child would be referred to using the pronoun “her”. The child’s parents consented to the application.
Evidence of the social worker
The social worker told the court that the CFA was seeking the care order to the age of eighteen years to support the parents, who were not in a position to care for the child due to safety concerns for the other children in their household. The child had diagnoses of reactive attachment disorder and a query of PTSD, in addition to gender dysphoria. The CFA sought the order to ensure the child received the required level of specialist care, which was beyond the parents’ capacity.
The child had been in the care of the CFA for a number of months. The judge previously directed the CFA to write to CAMHS regarding the child’s needs. The social worker stated that CAMHS in a particular county had delayed offering services because they had not previously dealt with a case of gender dysphoria.
The child had recently moved placement. While in that placement there had been some concerns that the transfer might disrupt engagement with CAMHS, but assurances had been received that the child would remain with the current CAMHS team for the next six months, with a potential transfer thereafter. The social worker explained that engagement with CAMHS was required before any secure placement could be offered. The child initially stated she had no intention of attending CAMHS but had changed her position when informed that access to a phone would depend on her engagement with the service.
Overall, the social worker stated that the child would prefer a placement in Dublin, but the current proximity to Dublin was viewed as a compromise. There had been some positive developments, including the child allowing staff to assist with her hair. However, the social worker expressed concerns that the child rarely left the house except for appointments and shopping.
Staff had also noted the child’s use of bleaching creams on her face, resulting in a noticeably lighter complexion in certain areas. The social worker stated that no further products containing bleach ingredients would be accessible to the child.
In relation to education, the priority was engagement with CAMHS. Discussions had taken place with a Special Educational Needs Organiser (SENO) regarding education, but this was not being progressed at present due to the child’s borderline functioning and further attempts to identify a suitable placement.
The social worker confirmed that the priority in addressing the child’s gender dysphoria was engagement with CAMHS and associated therapeutic work.
Representations of the guardian ad litem
The guardian ad litem (GAL) made representations from the body of the court. She stated that any therapeutic work would need to be long-term and involve the ability to sit in silence and connect with the child. The GAL noted that the child felt disconnected from the world and that significant work would be required until she felt comfortable in her own skin.
When asked by the judge what the child had said, the GAL reported that the child wished to be female, to live in America, and to make connections with someone related to her by blood. The GAL stated that the child did listen, could hear what was said to her, and was capable of making decisions in her own best interests, depending on how issues were framed and whether she chose to engage.
Judge’s ruling
The judge stated that nobody wanted to be responsible for these types of decisions, but the priority was to support the child until she reached the age of eighteen years. The judge noted that in other jurisdictions there had been a pullback from providing medical care to children under eighteen in similar cases and indicated that she considered this approach was probably appropriate.
The judge observed that it was an impossible situation for the parents. She stated that historically, such cases had been referred to the UK, but referrals had stopped following scandals at a particular clinic. The judge recommended that the parties might benefit from speaking with Dr Keith Holmes, a psychiatrist in Dublin who specialises in these matters.
The judge emphasised that the role of the parents and the CFA was to protect the child in terms of safety. The priority was to bring the child safely to the age of eighteen years, at which point she could make her own decisions. The judge noted the child had been adopted at a very young age from an African country and that there was an absence of information regarding her birth family.
The judge thanked the parents for consenting to the order and making the decision straightforward for the court. She made the care order until the age of eigtheen years and directed a review in a number of months’ time to receive an update on the child’s engagement with CAMHS and other interventions. The GAL was directed to remain involved in the case and to update the court as appropriate.