ICO granted for baby due to ongoing substance abuse by his mother – 2023vol1#5

An interim care order was granted by a judge in the Dublin District court because of concerns for a very young baby, whose mother had been involved in substance abuse and whose older sibling was already in the care of the State.

The guardian ad litem (GAL) in the case supported the application and updated reports had been handed into court on behalf of both the social worker and the GAL. Evidence was also given by the social worker and team leader and the manager of the residential drug treatment centre where the mother had been a resident.

The court initially heard evidence that another sibling had entered care following a voluntary care agreement. He had previously been in the care of his mother for two years. However concerns had been raised regarding the alleged severe level of neglect due to the mother’s ongoing drug usage. The court heard that clothing was not appropriate, that he had witnessed his mother’s drug use and that the safety plan that had been devised was not followed by his mother. Further evidence was given in relation to the behavioural issues which the foster carers had encountered. These issues were being attributed to his early childhood at home. This evidence was objected to by the mother’s lawyer on the basis that the interim care order before the court did not relate to that child.

The lawyer for the Child and Family Agency (CFA) argued that it was relevant on the basis of “potential, present and future neglect”.

The judge said “families are like a ball of wax and are not discrete” and allowed the evidence.

Team leader’s evidence

The team leader gave evidence that the older child had been referred to the primary care team for occupational therapy and to a psychologist as he had very significant behavioural needs. The child had undergone an assessment and the root cause of his issues was said to be due to the neglect and trauma previously experienced.

The team leader said she was aware the mother had attended a detox programme but had not completed it. The social worker commended the mother for the efforts made before the baby’s birth, that it had been her “best effort”, and she did show motivation, but that she had a long dependency on drugs and her addiction was linked to her own mother’s addiction which further complicated matters.

The interim care order for the older child had been sought initially as the mother had not been able to renew the voluntary care arrangement. In addition, she was uncontactable and she could not give consent to emergency medical treatment following an accident the child suffered at pre-school.

The team leader went on to state that the mother needed to address her own drug issues and then she could start on the process to address the parenting issues. The social worker did not doubt she wished to be a parent but she said she had not demonstrated any capacity to do so. She said that inter-generational drug use was a consistent factor.

The team leader was asked whether the mother availed of drug treatment programmes and she said she had not. She said her attendance at the residential treatment centre was the first period of consistency with no evidence of drug usage. She was not aware of any other time when she was stable.

In cross examination the mother’s lawyer said the mother had been pregnant at the time and had been advised not to take methadone. She also said that the engagement had been her best efforts and she was on a positive trajectory. The team leader agreed that it was more positive than when the mother had first started. The mother’s lawyer also referred to positive urine analysis on two occasions during the previous month.

On re-examination the team leader said the mother had attended a treatment centre for a number of months and following the birth of the baby she had also been in a residential placement but had not completed that stay. She did agree that there had been a period of positive engagement.

Evidence of manager of residential drug treatment centre

The manager of the residential drug treatment centre provided some background information as to the services that are provided by the centre. He explained that the place where the mother was placed was for women only and was effectively a community run by the women who lived there and that there was a hierarchical system in place supported by professional therapists and counsellors. He said that all of the women had a role, perhaps in the kitchen or in other places.

The manager said that women who attended the centre usually remained on the programme for six months with a further six months as a day programme with supports and then in aftercare. He said that people would tend to spend 18 months on the programme with a graduation at the end. There were 10 mother and child places.

The manger was asked how the mother came to the service and what was the plan. He said they usually worked with people as they arrived. He said that mother in this instance had come from another centre and she needed an emergency bed as she was having a baby and needed support. He said people had to stop using drugs before coming in. On the day of the mother’s admission, he said she had used cannabis, however she was allowed to be admitted in “exceptional circumstances”. Her urine was monitored over a number of days.

The mother’s lawyer objected to the admission of that evidence on the basis there was no documentary evidence before the court. The judge allowed the evidence as being relevant.

The judge said not all of the commentary was negative for the mother and that the court needed to hear the full picture in order to be of assistance to her. The interim care order was a serious application.

The manager said the mother had engaged well with the programme and had had no positive drug analysis tests for a number of months. He said the first number of weeks consisted of orientation and she had been willing and engaged and a part of everything. She had progressed well and things had beenlooking good.

As part of the programme, if a resident was doing well, they were allowed to leave the centre for 24 hours to engage in social activities for outside of the centre. The time out was planned in advance. The manager said that the mother admitted using drugs when she was out and she also stayed out longer than the permitted time. She was away for two nights. He said it was normal for residents to regress. Before she self-discharged there had been no huge indications that she was struggling and no major indicators. She had told the staff she was not happy, but the manager said that was a normal experience.

On cross-examination the manager said he would love to have the mother back. The mother’s lawyer said the mother was eager to re-enter and re-engage. She put it to the manager that the mother had been concerned about respiratory illness in the complex and although there were doctors and nurses there the mother felt they were not addressing her concerns.

The manager confirmed that if the mother were to re-enter the process would take two weeks as she would need to provide two or three samples beforehand.

Evidence of family support worker

The family support worker said her role was a little different to normal in that she provided holistic help. She said she had been helping both the mother and her mother as they had both been living in the same house. She had started working with the mother a number of months earlier. The family support worker said she had spoken with the social worker about the mother as she had had a number of worries and that she felt that she had been under a lot of strain.

The family support worker visited the home and the grandmother did not know where the mother and the baby were. Her mother did not want the baby to be taken. The child’s grandmother felt it would be good for the mother to get back into the residential placement.

Asked if she knew why the mother had left the residential centre, she said she had felt the barriers kept being moved, she was being held to different standards and that she had felt isolated. The mother had concerns about the baby. She had seen the nurse but not the doctor. The mother felt the baby was unwell and needed an antibiotic. The mother left the residential centre and got an appointment with a doctor for the baby. The support worker knew about the slip with the mother having taken drugs.

The mother’s lawyer said the mother was now on a reduced dosage of methadone.

Evidence of the social worker

The allocated social worker said that there had been no other option but to apply for an interim care order. She said that there had been a pre-birth conference in respect of the baby and that he was placed on the child protection register pre-birth.

At the time the allocated social worker had taken over the mother was already in a treatment centre and it had been agreed that she would be transferred directly to the residential treatment centre following the birth.

The social worker was asked how the mother had got on in the first treatment centre and she said that she had gotten on well and had completed four weeks there before delivering her baby in the maternity hospital. She said the baby was small when he was born and that was due to the fact that the mother had been smoking during the pregnancy. On discharge from hospital she could not be admitted directly to the treatment centre as she had been using drugs and the baby had been admitted into voluntary care for one week. The mother had admitted using drugs in the taxi on the way to the treatment centre.

She said the mother had progressed well up in the centre to just before Christmas. Asked about the outing, she said she understood that the mother had stayed out longer than had been permitted, that she was uncontactable when she was out.

The social worker received a notification that the mother had had a slip in her drug use and she was told that it was because her grandmother (nannie) had had a turn and she was concerned for her. The social worker was asked about the home visit that she had conducted before Christmas. She said the mother had been in touch with the residential treatment centre and that the key worker agreed to take her back under stricter conditions. The mother re-entered that day.

Concerning the mother’s self-discharge, the social worker said she had found it hard to cope and had been having suicidal thoughts.

The social worker said she had serious concerns about the mother and her mother living together as they relied on each other and therefore they would fall into a chaotic pattern including drug use.

She was asked to outline her concerns for the baby and she said that she was concerned that he was would not be in the care of a responsible and sober adult. The baby’s health and well-being was at risk and that in the home environment his needs would not be met.

The social worker said the application had been adjourned to allow a safety plan to be put in place. Initially the social worker was calling less frequently to the home however after the adjournment the social worker called every day.

The home was unsuitable. She said that there were no sterilisation facilities, the cot was not assembled. The dog had apparently eaten the mattress. The baby had been sleeping in the bed with the mother. There was a wine bottle in the bin.

When she called the mother and baby were out, and the grandmother was aggressive and bleary eyed and dishevelled. She thought she had been using a substance.

The safety plan had stipulated that there would be three supervised urine analysis done weekly, that the mother would engage in the community and would not leave the baby with her own mother. She said that the mother consented to all of the plan.

The CFA lawyer asked her if she had any concerns since the plan was put in place and she said that only three sample had been provided and two of them had been positive and one result was outstanding. She said the mother had attended another community service. She was meant to go every day but had only been once, and twice to provide samples. The baby had also been left in the care of his grandmother which was in breach of the plan.

The social worker was asked about the mother’s drug use and she said based on the results from the screening service it would appear that the mother was using daily as was the grandmother. She said the mother had not engaged with services and that she had left the residential drug treatment centre in an unplanned manner. Prior to getting the analysis results she said the mother had denied she’d had a slip. When the results were put to her the mother said she was upset about the baby being taken from her.

The social worker said that the only way for the mother to maintain sobriety was to go back to the residential treatment centre.

The mother had a lot of work to do for herself before looking at her parenting. She had a lot of work to do with regard to her drug addiction and there was a long road ahead.

The mother’s lawyer said that the mother was willing to re-enter the centre and was eager to do so. The social worker said that she did not feel it was a viable option to enter with the baby. Initially the mother needed to enter on her own. It was the professionals’ opinion that it would not be helpful for the baby as his mother had not shown sobriety.

The mother’s lawyer said that the separation of mother and baby should be the last resort. She asked the social worker if all avenues had been explored. The social worker said that the mother had been afforded a lot of opportunity and that the impact of early trauma had been reflected in the other child.

It was put to the social worker that the issues identified in the home, relating to washing bottles and other matters, were surmountable. The social worker did not think that the issues were small issues. She said in isolation that they may be small but altogether they were not.

Evidence of mother

The mother said the gardai and the social workers were at the house non-stop. She said she would go back into the residential treatment centre. In relation to her attendance at another community service, she said she never knew what time the social workers were coming and she would get a black mark if she was not there when they came.

She was asked if she was using on a daily basis and she said no.

In relation to housing she said there were threats on their lives in the area where they were living. She was waiting on a reference number and a meeting with the housing officer. She said she needed her own space.

She said she was willing to go back into the residential centre but needed the baby with her.

She was asked about the conditions in her home and she said that they were not immaculate but that they were clean. She said she did have a steriliser and sterilising fluid. She said the baby was taking baby formula now and puree but not solids.

In relation to the public health nurse, she said there were constantly people at the house. The baby was 13 lbs in weight and the health nurse was happy with him. She said the baby had hd a chest infection – he also had a big head that they were keeping an eye on. Other than that there were no major concerns.

Asked why she had left the treatment centre she said her own nannie was not well and that her nannie didn’t know her when she visited. She said her own mental health was suffering and she told staff before she left she was suicidal. Referring to her relationship with her mother she was her only child and they were co-dependent on one another. Her mother had previously been an alcoholic.


GAL’s evidence

The gave evidence of her historical knowledge of the family and with the other sibling. She said she had spoken to the mother before she had gone into the first drug treatment centre. She was struggling at the time and had said that she would go into the centre for treatment. The GAL also met with her in the second treatment centre and found she was insightful, honest and had been making very positive progress. Since self-discharging she said she had been under strain and had been struggling. She was also slipping into drugs again.

The GAL said the best care was with the parent but that this was not possible. She said the mother had the capacity to care for the baby but was not supported enough and therefore the baby was at risk. It was a huge challenge becoming a mother and it was a huge challenge having a drug issue. It was asking a lot especially where there were no supports. She said the baby had been doing well but that he needed consistency and safety. She said the baby had had three moves in four months.

The mother had the capacity to care for the baby but she was using drugs and that was impacting on her care for the baby. She said it was necessary to prioritise what the baby needed and the mum was not able to do that – she was not able to make decisions and that the baby’s basic needs were not met.

The mother should be asked to go to the residential drug treatment centre. She needed to work on her coping mechanisms and then look at re-unification. The baby needed consistent care and safety and he was not getting that. She supported the interim care order application and said it was in the baby’s best interests.

Asked about the concerns regarding the separation of the mother and baby she said she was concerned about it but she was more concerned with the care needs of the baby.

The judge asked the GAL if the court made an order what would her opinion be in relation to access. She said that access needed to be frequent and reasonable that the mum and baby would need to see each other. It was necessary to maintain the bond and attachment. The CFA indicated that they would see access taking place three times a week. She thought the mother should return to the residential treatment centre without the baby.

In submissions the mother’s lawyer said that the threshold had not been reached, that all of the options had not been explored. She said that the mother would consent to a supervision order and would agree to go back into the residential centre with the baby. This option would not lead to separation. She said that the child was very young and proportionality needed to be considered. The severance of the bond was very serious and the CFA had not demonstrated that all other options had been explored.

The CFA’s submissions said that the evidence was clear as to the threshold and they referred to recent drug incidences and also to the historical concerns regarding the other sibling. They referred to the fact that while the mum had attended the residential treatment centre she had used drugs at the first opportunity and that she had self-discharged and again used drugs. The CFA said that the residential treatment centre should be availed of by the mother but not with the baby.

Judge’s decision

The judge said he had heard extensive evidence including the evidence of the CFA. He had heard evidence from the manager concerning the drug centre and the nature and extent of their service. He referred to the enormous lengths they go to assist people. He referred to the evidence of the family support worker and said that he had heard that significant resources had been provided to the mother.

He had heard from the mother and the GAL and he said it seemed that the options were exhausted. He said he was satisfied the threshold had been met and that a supervision order was not adequate. He granted the interim care order for 28 days and adjourned the section 18 full care order application. He said the mother had a strong bond with the baby, she had strong determination and was forthcoming and co-operative. He said that there was work to be done and steps to be followed and that the court would be concerned to try to support re-unification. He acknowledged his decision was upsetting for the mother.