Interim Care Order for African boy with complex needs – 2014vol4#22

An Interim Care Order was granted in a rural town for an African boy with complex needs whose father had died and mother had a number of health problems. The boy was in a special unit run by a private provider under an Interim Care Order. The judge also said that if the Department of Education did not respond appropriately to an application for home tuition for the boy he wanted the responsible person in the Department in court to explain their failure to do so.

At the outset of the case the judge asked to see the Certificate and Articles of Association of the provider, confirmation that it was up to date in compliance with company law and the Revenue Commissioners, the name of the accountable person and copies of all inspections by HIQA or the HSE.

“We have a history here where the State handed the care of children over to private providers and did not take much responsibility for them. It behoves the court to ensure the basic issues are correct,” he said. “There should be Garda clearance for each and every person in that unit. I need to see it in black and white. I need to know the qualifications and training of every person in that unit, I need to know what continuous professional training exists, I need to know the rate of turnover of staff. I am not suggesting for a minute this unit is anything but excellent.”

When the case opened the social worker said the boy had autism, ADHD and a moderate learning disability. He had been assessed in 2012 and was receiving autism therapy and attending a special school. However, the team involved in his care were very concerned about the lack of follow-up of his treatment at home, including him not taking prescribed medication.

Relations between his parents had deteriorated, and there was little communication between them about the boy. The father, a professional man, was working part-time and paying the mother €50 a week maintenance, which he then reduced to €30 a week.

There were also concerns about lack of food and heat in the house, and about him being locked in his bedroom. Both parents had medical issues and his mother was hospitalised for lengthy periods. His father was also ill and quite frail with a terminal illness. When the mother was in hospital the father told social services he did not think he could care for the boy, and he was taken into care under an Emergency Care Order.

He went into foster care initially, but his behaviour was very challenging and this broke down within 24 hours. He was taken by ambulance to the local hospital, where he spent two days, and was then transferred to the unit. The social worker agreed that his removal into care had been very traumatic.

Asked about the family’s background, the social worker said they came from an African country. The father moved to another African country when the mother was pregnant, and a few years later the mother and son joined him. Then they separated again, the father came to Ireland, and was followed here some time later by the mother and son. The family spoke their local language and another European language, so the boy had some knowledge of three languages, but it was quite difficult for him to communicate verbally.

The unit, situated in private grounds, specialised in autism and intellectual disability, and had access to a psychiatrist, an occupational therapist, a music therapist, a speech and language therapist, as well as having care staff. However, the boy had not had a medical examination as he was refusing to enter any form or transport or to move outside the gates of the unit. The social work team had just confirmed that a local GP had agreed to come to the unit to carry out a medical assessment.

Because he was refusing to enter any mode of transport the boy was not attending school, and the social work team had applied to the Department of Education for home tuition.

Asked by the judge if the circumstances of him going into care might have contributed to his attitude to transport, the social worker replied: “The circumstances of his placement were very concerning and not ideal.”

Judge: “Even for a child in the best state of mind to move to three different placements in that space of time would be very traumatic.”

Social worker: “Yes, judge. But even before that transport was emerging as an issue.”

She said that this unit had already been identified as suitable, but there was no bed for him immediately when the father requested help.

Asked about her concerns regarding his return home, she said that there were concerns around his basic care, food, heating, him being left locked in a room, managing his behaviour, child safety, a lack of stimulation and not following through on the recommendations of the care team. She said it was in the boy’s best interests to remain in the unit where his basic needs were being met and he was also receiving appropriate therapy for his very complex special needs.

The social worker said that the CFA was also seeking the appointment of a guardian ad litem for the boy, who could look at his needs and how they were being met from an independent viewpoint.

The mother’s solicitor asked her if she was aware that the mother had been entirely dependent on her husband for income until his death when she began to receive disability allowance, and that it was the mother who had raised with her the issue of money for food and clothing. The solicitor said that the mother was concerned about the boy wearing ill-fitting clothes when she visited him in the unit. The social worker said he had recently had a growth spurt but his clothes seemed to fit him.

“He is receiving no education whatsoever at the moment,” the solicitor said. “If he was in my client’s care and not going to school you’d be down on her like a ton of bricks.”

“There are special difficulties because of his complex needs and issues around transport,” the social worker said. “There is correspondence with the Department of Education. They sent the application back to me seeking clarification.”

“That’s bizarre,” said the judge. “You are writing on behalf of the CFA. When was it sent back? If the solicitor was to write to them, they could say there is no application before them. It might be a good idea, if there is no progress, for the court to sub poena the Department and ask them to come here and explain.

“It seems to me, if they send the application back to you, you go back to the end of the list again. I find it extraordinary that this would happen.”

The doctor from the special unit told the court he met the boy the week he arrived in the unit. He was preparing a visit between him and his father, who was nearing the end of his life, but after observing the boy he realised this was not appropriate.

“His behaviour was sexualised, he was trying to touch both males and females in their genital areas. This was not age-appropriate behaviour. It was an aspect of his behaviour we were not expecting and was indicative of trauma. He may have experienced sexual abuse, but there was no evidence of where it might have occurred,” he said.

He told the court that the boy was living in a very structured environment and was having music therapy. He had phobias in relation to transport and blood tests, which were there before he came to the unit. The unit operated a neuro-behavioural model, providing both assessment and therapy.

He said he had asked the mother if she could explain the sexualised behaviour and her solicitor said she had concerns after she had been hospitalised two years earlier and saw changes in her son’s behaviour when she came out. She said her husband was evasive when she asked him about it. The solicitor asked if the way in which he was received into care was itself traumatic, and the doctor agreed it was, and that it was unusual that he did not want to go outside the gates of the unit.

A care-worker who had carried out a parenting capacity assessment said that both parents had problems with the boy’s behaviour at home, especially around bed-time. The father usually got him to bed, because of his physical strength. There were safety issues in the house as the boy could put his hand into hot food or his foot into the fire. The mother said she had locked him into his room for safety reasons.

The care-worker said she was concerned about how the mother would manage the boy alone at home. He would not get into the transport to go to school and would be at home full-time. She had to go to a lot of medical appointments. The mother said she would avail of respite and the autism services if she had to go to hospital, and that she had friends in her church who would help.

The CFA solicitor said she had been instructed by her client to seek a Care Order for three months.

“That’s rather bizarre,” the judge said. “Whoever made that suggestion does not understand the law. A full Care Order has to be carefully considered by the court. A Section 17 application has a different threshold. What is sufficient for a Section 17 order may not be sufficient for a Section 18. The legislation does not provide for a three-month Care Order.”

The judge then expressed his sympathy to the mother and the boy for the death of the father. “It is very difficult for the mother coming to this country, with a different culture, language, weather. It would be much more difficult in the circumstances outlined to me. A terrible tragedy befell the family. The father succumbed to a serious illness. The mother was left alone to deal with the vagaries of life and her own health difficulties. It would make it extraordinarily difficult for anyone. On top of that, to come into court and have her life discussed and analysed by strangers is a terrible thing. She is an extraordinary woman to put up with it all. I admire the way she can cope with it.

“She is doing what any mother would do – seeking to rear her child and has gone about it in a proper way, instructing a solicitor.

“Section 24 of the Child Care Act sets out the role of the judge, the child’s interests are foremost, ahead of the parents. The boy has extraordinary needs – autism, ADHD and a moderate learning disability. It is an extraordinary burden on his shoulders.

“The child’s interests are the foundation stone of this type of legislation, not just here, but throughout the world, with the UN Convention on the Rights of the Child. Having heard the evidence I believe it is in the best interests of the boy that he be placed in care and that the CFA have established the threshold under Section 17.”

He said he thought the social worker had done her best for the child. “It is outrageous that she had to face obstacles like when she seeks home tuition it’s thrown back in her face. We urge the CFA not to take that sort of nonsense from anyone. This young man is entitled to education commensurate with his abilities and talents. If the Department of Education and Skills has not responded adequately bring back an application within seven days, identify the person responsible and sub poena them to come into court and explain to me why the young man is not getting the education he needs.”

He also directed the CFA to pay the full costs of the mother’s travel to visit her son, and appointed a guardian ad litem for the child.