Interim Care Order granted while reunification planned – 2014vol4#18

An Interim Care Order was granted in the District Court for an infant that had been taken into emergency care the week previously. The parents consented to the order on the basis that they could see their daughter five times a week with the aim of reunification. In the meantime supports and assessments were to be put in place for the parents.

The young mother, who herself had been in both regular care and secure care, was extremely upset at the start of the hearing. She told the court that she had just heard her child had been dropped during a hospital appointment, the social workers were not watching her, she said, and she fell off the bed. The mother was sobbing.

The child got dropped in the hospital, the social workers weren’t watching her, the baby is ok but still … I have never dropped my child, I love my child,” she said.

The mother told the court that the Guard had been lying last week when she had said the baby could not sit up on her own. She showed a video to the judge on her mobile phone, the father came up and spoke to the judge with his partner.

My initial impression is that [A] looks like a very healthy baby from the video shown, it is evident the child is giggling in a spontaneous fashion and appears to be having great fun,” said the judge.

The mother told the judge that last week when the public health nurse had asked to see her she had made an appointment with her for the following day.

Is there anything else you want to say?” asked the judge.

My child is the most important thing to me and I miss her,” said the mother.

If I’m going to be making the order – I know the parents are consenting – I want to know what is being done about what help and supports the family needs, realistic practical information is what I want, not a vacuum of someone being referred to someone,” said the judge.

The barrister for the mother said that a degree of insight needed to be shown by the social workers in relation to the mother, as she was a product of the care system herself. The barrister said that a situation had been engineered to get around the Supervision Order granted last week, the day after it had been granted the social worker was around the following morning at 11.30 am with a Guard.

The judge said that the parents were consenting and she wanted to know what the parents needed so that it would be provided for them to help them resume the care of their baby.

During the hearing, the court was told that two months previously both the family support worker and key worker had left, the family support worker had left on sick leave and not been replaced. The parents did not know why the key worker had left and not been replaced. “Everything was going great when we had our family support worker and key worker,” said the father. The social worker was unsure why the key worker had left and was aware that the family support worker had not been replaced.

The drug treatment doctor

The doctor who had treated the mother at his methadone clinic for two years told the court that she had advised she was coming off methadone mid-August. “It would be very difficult to detox yourself,” he told the court. She had been on 80mls of methadone. Last week she had done urinalysis at the clinic and tested positive for heroin.

CFA solicitor: “Even with a positive sample, what does it show in relation to capacity of a person to care for a child?”

Doctor: “I don’t think it necessarily indicates anything, I think there’s an over-reliance on urinalysis. [Heroin use] can vary from injecting once a day to smoking it twice a week. I don’t think you can say a person smoking twice a week can’t parent. I don’t think there’s a connection between capacity to parent and urinalysis.”

CFA solicitor: “Could it impact on the care of the child?”

Doctor: “It could impact but it doesn’t necessarily, there’s not an automatic connection.”

The father had tested positive for heroin and cannabis last week.

Mother’s barrister: “People stabilised on methadone, under your direction, following your supervision, can follow a relatively normal day to day life…hold down a job?”

Doctor: “They can, there’s no correlation between urinalysis and day to day activity.”

He said that benzodiazepine usage was often much more problematic and rendered patients much more dysfunctional. The mother’s presentation was always consistently good, she had never tested positive for either benzodiazepines or cannabis. She had ceased her methadone treatment at the start of September.

Mother’s barrister: “In terms of her detoxing, you said it would be difficult, she has tested positive recently, at the moment she has taken it very recently, and she is not on medication to deal with that issue, do you think it would be in her best interests to attend a clinic for methadone?”

Doctor: “Methadone can be extremely helpful for anyone using heroin, so the implication is clear…”

Public Health Nurse (PHN)

The Public Health Nurse told the court that she had known the couple since late 2013, she had been on seven home visits and they had made 23 visits to her clinic.

When the baby had been born, the parents were living in a small flat but “they had made space.” They were first time parents and eager for information about their baby’s needs. They were now living in a small house. She had found the parents co-operative, but she had not seen as much of them in the last four months.

The baby had had a developmental assessment at nine months, the outcome of which was that her overall development was as expected except for gross motor delay in the lower limbs – she was not pulling herself up to standing or walking around the furniture, as you would expect at that stage.

I would have given the parents guidelines how to stimulate her, spending time out on the floor out of the buggy,” said the public health nurse (PHN).

The PHN had met them a couple of times on the street in last month and they had explained they were spending a lot of time outside of Dublin due to a death in the family.

Earlier this month the father and baby had come to the health centre for a check-up, she had found A’s development appeared fine but she still wasn’t pulling up to standing or walking around the furniture. The PHN had suggested a book of parental information which highlighted information on the importance of play. There was an appointment in early December for the area medical officer to review A.

The public health nurse was aware that A had not been brought for three neo-natal hospital appointments.

During the week previous to the Interim Care Order hearing, when the Supervision Order was in place, the social worker had asked the public health nurse to contact the mother about visiting her. The social worker wanted the public health nurse to visit immediately, however the mother asked her if she could come to the clinic the following day because she had had a lot of professionals visiting the house that day (the same day the Supervision Order was made).

The PHN told the court that she and the mother both agreed over the phone for a clinic visit the following day.

Social worker

The social worker told the court that she had become allocated to the case because the previous social worker had felt quite threatened by the mother, who had been aggressive towards her during home visits.

The day after the Supervision Order had been made the social worker called to the parents’ house with a plain clothes Guard at 11.30am. She told the court that when they identified themselves the mother became highly agitated. “You’re making a show of me, why are you calling so early in the day?” she had asked.

When the mother saw the Guard’s radio which would have identified her as a Guard (to her neighbours), she had become very annoyed, the social worker told the court.

The social worker told the mother that the public health nurse (PHN) would be doing a home visit that day, the mother agreed on a visit for 3pm. The social worker rang the PHN and told her this.

The social worker told the court that she had been concerned about the mother’s presentation. “She was dishevelled looking, very agitated, very aggressive, accusing us of trying to aggravate her and harass her. There was a black substance across her teeth.” The social worker said she knew that sometimes people who have substance misuse have black marks on their teeth.

The judge wanted to know if this was based on medical opinion, the social worker said it was not.

Both she and the Guard had been concerned about the mother’s appearance that morning. The social worker said that the PHN did not get to see the child, she had rung the mother who had felt she was being harassed that day by professionals, that too many people were calling, an appointment was offered the following day at the clinic as an alternative, which was accepted.

The social worker told the court that the Gardaí invoked Section 12 of the Child Care Act that evening and the infant was brought into care.

So there was no refusal of access [of the PHN]?” said the judge.

The question is when you spoke to [the PHN] was your understanding that the public health nurse and mother had made an arrangement themselves independently of you?”

The social worker said she had advised the Guard that the PHN had not gone to the house and it had been arranged that the mother would visit her at the clinic.

Judge: “Was the Guard informed by you that access to the PHN had been refused and no reference made to the appointment the next day?”

Social worker: “I suppose a home visit was refused.”

Judge: “You have to give both sides. Did you say it was rearranged?”

Social worker: “Yes.”

Judge: “Evidence was not given that an alternative appointment was given and agreed to. [during the ECO hearing].

Evidence as I was given, as I recall, is that it was put to me that [the mother] and the father refused access to the PHN on the [date], and that was further grounds as to why an ECO should be granted, do you recall that evidence being given to me?

In these matters it is absolutely essential there is entire accuracy; people are entitled to have the full facts in front of the court, not the half facts.”

Social worker: “We were concerned about the mother’s presentation.”

Judge: “That’s a separate matter, the PHN gave entirely difference evidence today, the parents have visited her clinic 23 times in the child’s short life, they facilitated seven home visits, she found them very co-operative, they rearranged the visit, it is entirely unfair to parents if half of a story is given and I’ll make no further comment at this point, I want professional opinion as to the welfare of [the child] at this point.”

The social worker told the court that after the ECO was granted, the parents agreed to urinalysis. They had been asked to provide it once a week and the mother had offered to give it more often. Access had been taking place for three hours a day except on weekends. The mother had been very emotional at the first visit and cuddled the baby, she played with her and was very appropriate.

The social worker felt that during access the parents spent a lot of time focussing on the court case, implying people were telling lies and saying they were distraught. She felt they should have been focussing on providing a nice atmosphere for the child instead of venting frustration to her and each other. Sometimes the mother could be very aggressive and disengage; her mood fluctuated from one extreme to another.

The social worker felt that the child did not have a major reaction to her parents one way or the other.

The parents had been invited to attend a general paediatric review of their child in Temple Street, they had arrived an hour late and the mother had been in an extremely heightened mood. It was very difficult to work with the parents when there was such a level of aggression all of the time, said the social worker. This aggression was also in front of the infant. The social worker was recommending they attend Accord (marriage counselling service) and counselling.

The social worker was concerned about the level of interaction of the infant with the people around her. “In my view she would be quite delayed.”

The judge asked had this been identified as a problem in the general paediatric review. The CFA solicitor said it had not.

These issues have to be looked at by someone with expertise to give an opinion on the matter,” said the judge.

The social worker told the court she was satisfied there were sufficient grounds to make the ICO.

The night team leader

The night team leader told the court that she had been called in by the Gardaí when Section 12 was invoked. When the team leader arrived the infant was in a soaking wet babygro and smelt of urine and soiling. Her baby vest had dried faeces on it, the nappy was full and there were dried faeces around her bottom, as if it had not been cleaned properly. Her toe nails and nails were black. Her hair was matted with dried food that had been there for a period of time. The team leader said that she had been significantly concerned because the infant had not been in a good state.

Before the child had gone into care, the team leader had done a home visit earlier in the month. The mother had been extremely aggressive and threatening and she had said she would slice her throat and box the head off her. Garda assistance had been asked for.

It’s been impossible for us to address anything meaningfully with the parents, staff are intimidated, they are frightened to raise issues, although [the mother] says she wouldn’t actually carry out the threats,” said the team leader.

We need mutual respect in all dealings, when we can get on well she is a lovely young woman. I am quite fond of her. I see the vulnerability and what she has gone through.”

Is there anything that can help the working relationship?” asked the judge.

I’m not sure but I’m open to suggestions.”

The team leader told the court that she was making a recommendation for a psychiatric assessment of the parents, as a psychological assessment might not be sufficient. She had concerns about their drug use and level of aggression, so a more complex assessment was needed.

We’re hoping to gain some guidance in terms of working with the parents, both parents have had very difficult childhoods which is impacting on their ability to parent themselves,” said the team leader.

She did not know how quickly the assessment could be arranged and she would have to look into the appropriate service. Marty Mayo therapy would also be recommended. This supported parents with regards to attachment and development of children, through positive reinforcement and guidance.

The PHN would give guidance to parents regarding gross motor skills.

The team leader felt that access should be reduced, that it should be about quality not quantity. She felt the parents were overwhelmed with the amount of access they had and had told them that the way they were talking was having a negative impact on the infant.

She suggested a change of venue for access visits as she felt that the social workers’ presence during access was not helping the situation. Access workers would be available at the proposed HSE venue.

The barrister for the mother told the court that the circumstances leading to the child being taken out of the home were very stressful for the parents. They had not been given an opportunity to follow up with PHN appointment as the Guard had arrived the following day at 11.30am.

The barrister for the father told the court that the father said he was not a heroin user and that he had used codeine because he had had surgery. He was on a waiting list for MOVE (Men overcoming violent emotions), he accepted his emotions overcame him and would like to deal with that. It did not happen around his child. He would also like couple counselling.

The CFA solicitor said he would try and source another service for the father similar to MOVE as he had been on the waiting list for two months.

The judge granted the ICO under section 17.1(b), she was not satisfied that the criteria under Section 18.1.a (for a full Care Order) of the Child Care Act had been met:

18.-(1) “Where, on the application of a health board with respect to a child who resides or is found in its area, the court is satisfied that-

(a) the child has been or is being assaulted, ill-treated, neglected or sexually abused.”

She was satisfied that the criteria had been met under section 18.1.b and 18.1.c

(b) “the child’s health, development or welfare has been or is being avoidably impaired or neglected, or

(c) the child’s health, development or welfare is likely to be avoidably impaired or neglected,

And that the child requires care or protection which he is unlikely to receive unless the court makes an order under this section.”

The judge noted that both parents were agreeable to the ICO and she wanted to hear what steps the parents needed to assist them. By helping themselves they would help their baby. She said the parents had attended and been entirely honest and open. She noted the parents were committed to engaging with the addiction services and taking the specialist’s medical advice.

She directed the CFA to conduct access in a manner that supported the parents and advise them on parenting skills. She noted the CFA were committed to and the parents were agreeing to Marty Mayo therapy.

The judge noted that both parents had agreed that if they engaged in any aggression in the presence of their daughter during access, that the matter would be re-entered by the CFA in relation to access.

She noted that both the CFA and the parents agreed from that day forward to communicate in a respectful fashion.

She noted that the father had been on a waiting list for services from MOVE and directed the CFA to ensure this service was expedited and made available.

The judge noted that the mother consented to all existing psychological and psychiatric assessments [from her time in secure care] being made available to the CFA to inform the parenting capacity assessment.

This is a case where the CFA are going to work with these two young parents for reunification, this will be done on the basis that everybody has to be respectful, the parents will cut out the aggression, stick to the straight and narrow, move forward, and mind themselves.

I want to give these people a chance, everybody needs a chance,” said the judge.

She reduced access from three hours a day to two hours, to start no earlier than 11 am. It would commence at the proposed HSE venue with access workers and without the presence of the social worker.