Children of homeless drug user taken into care – 2013vol3#4

A full care order was granted was granted for two young children of a homeless drug user in the Dublin District Court after a two day hearing. The mother’s own parents had also been drug users.

She herself had started using heroin at a very young age and had had her first child aged 15. The children were her fifth and sixth children, all of her other children had also gone into the care of the state. The court heard the HSE were involved with the mother on an on-going basis for over 20 years prior to the birth of the older of these two children, child A.

The mother did not attend the hearing on the first day. However on the second day she attended and regretfully gave her consent, conceding that she could not care for the children herself. In giving her decision the judge said there had been “unintentional harm and neglect due to long-standing substance abuse, resulting in passive neglect.”

The father of child A attended on day one. Clarification of his paternity with DNA testing had only recently been achieved. He was supportive of the care order. The father the younger child, B, (originally from another jurisdiction) did not participate in the proceedings or involve himself with his daughter. He had served time in custody in Ireland due to drug charges and had been evasive with the HSE and vague as to where he lived, said the HSE solicitor, but he had been served with notice.

The social worker told the court that the mother’s doctor informed the social work department when she was 20 weeks pregnant because she was not co-operating in providing urinalysis at the drug clinic. After A was born her parents were allowed to take her home following a management meeting. The mother had not tested positive for opiates on the day of discharge, but had the previous day for cocaine. She had attended a detox programme prior to the birth and was stable on methadone maintenance.

The parents were given a plan to care for the baby safely which included that they comply with urinalysis and refrain from drug use; co-operate with family support services; co-operate with the social work department; and attend GP services and any other appointments for the baby.

However from the start there were difficulties getting them to engage. Furthermore the mother was going out all night, leaving the baby with father A in their B&B accommodation.  The mother was not present in the accommodation when the family support worker called at the pre-arranged time and she missed several weight checks and vaccination appointments for the baby. There were also concerns regarding relationship breakdown and drug use.

Within three months the mother tested positive for cannabis, opiates and benzodiazepines. The social worker said she was very concerned and visiting twice a week. Both parents spoke about the other parent using drugs. In early 2012 a plan was put in place, they were told they needed to be drug free and seek separate accommodation, the mother was told to seek supported accommodation with respite for child A at the weekends.

By the end of January the baby had only gained one third of her expected weight since the last weight check and was failing to thrive. After an emergency case conference, a medical report from the Children’s Hospital showed that although she had reflux, there was no organic cause for the baby not to gain weight. By early February an Interim Care Order was sought due to serious concerns regarding the neglect of child A and to allow the mother to stabilise on her drug use and find supported accommodation.
The child moved into her foster family and made significant improvements in relation to weight gain. She was thriving and the paediatrician and dietician had discharged her. The social worker agreed with the HSE solicitor that it would be fair to say the child had a reflux condition and was hard to feed, the parents had brought her to hospital where baby Gaviscon was recommended. She would have needed significant perseverance with feedings.

The HSE had wanted to maintain the bond between the mother and daughter but as time went on she did not engage in the visits, she had missed 41 access visits with no explanation or contact. She had attended two accesses last month for the first time in over six months.

The mother had not addressed her addiction, said the social worker, she was not providing urinalysis or meeting with her doctor, the social work department had no way of knowing what her drug use was, she refused to engage in counselling for addiction and was still homeless. She had been offered several supports from the social work department and the family support worker, Threshold appointments were set up, but she did not establish any level of engagement. The mother had shown no ability to change, said the social worker.

“If you can genuinely characterise the treatment of the daughter as neglect why was she still in the care of the mother in January?” asked the mother’s solicitor. The social worker told him they did have concerns and “they would fall under neglect.”

The Interim Care Order had been applied for with a view to reunification. “We wanted to give her every chance,” said the social worker.  But there was “very little progress in relation to drug addiction and accommodation after the baby went into care.” However she confirmed they were still willing to engage with the mother if she were to turn the corner.

The acting primary support co-ordinator told the court that Father A was seen as the protective factor from the beginning of the work with the family. He was clear on what that role entailed. There were no concerns in relation to his behaviour during visits from the family support worker. When father A moved out there was no longer the protective factor. The mother needed a level of supervision they could not provide for her.

The doctor from her drug clinic had told the court he had been treating the mother for 13 out of the 20 years she had been attending there, for use of heroin, cocaine, cannabis and benzodiazepines.  She attended the clinic daily for her methadone and was pleasant with all members of staff. She had a 40 per cent co-operation rate of urinalysis, but had not attended psychotherapy to address her substance misuse issues or avail of anything other than methadone.

“She needs to take an active part in her own recovery,” said the doctor. “She’s not beginning to address her issues … she had very complicated psychosocial problems.”

The mother’s solicitor asked the doctor if he believed she needed “a drying out place.” He said a patient would need active work such as psychotherapy prior to hospitalisation otherwise it was pointless, it was his view she knew what to do but for whatever reason she was not doing it. If she was to engage, a year would be realistic, but she had not done so, so far.

The consultant paediatrician from the children’s hospital told the court that when child A was admitted in late January 2012 due to low weight gain, it was significantly sub-optimal and she had a failure to thrive. However the baby gained close to 400 grams in a few days, and all tests came back negative. She was treated for the reflux. “In a very short time frame it was obvious she had not got enough milk, once she got the right volume of milk she gained weight.” She told the mother’s solicitor that it had not been deliberate.

With regard to child B, the social worker told the judge a pre-birth assessment was done to identify any possible risks to the unborn. A number of concerns were raised, the mother was not attending her ante-natal appointments and had tested positive for benzodiazepines, cocaine, and cannabis before she stopped providing urinalysis samples. She was evicted from her accommodation that summer as she was staying out all night and she became homeless. Due to her drug use it was decided an ICO would be applied for after the birth.

The baby was born with withdrawal symptoms. She was having tremors, she had to be swaddled and kept in a dark room for the first six weeks of her life. A condition called neurofibromatosis was being watched.

The social work department could not properly assess the mother’s parental capacity until she was drug free. She felt the mother had the capacity to change but no willingness to do so, there had been no change in the last 18 months. There were attachment difficulties as she had only seen child B on four occasions since her birth, she did not enquire after her medical needs and had no level of engagement.

She told the mother’s solicitor that when the first ICO was applied for the mother was very clearly told her steps forwards to become drug free. The mother asked the court: “If I came back in 12 months, if I done everything I’m supposed to do … can we look at it then.” “There’s always a possibility of coming back and looking at a care order, but you have to put the work in, do you follow that,” replied her solicitor.

The judge granted a full care order for both children until the age of 18 and directed that the HSE provide the mother with therapeutic support so she could engage in access, as it was in the best interests of the children. “The mother had a very difficult life and is acknowledged by all professionals working with her as a very personable woman,” said the judge.

The court’s judgment in this case is published on the Courts Service website,